- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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grievance and appeals coordinator
Found in: Lensa US 4 C2 - 3 days ago
Randstad Los Angeles, United Statesgrievance and appeals coordinator (ca residents). · + los angeles , california (remote) · + posted 4 days ago · **job details** · summary · + $ $22 per hour · + temporary · + high school · + category healthcare support occupations · + referenceAB_4523235 · job details · This posi ...
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grievance and appeals coordinator
Found in: Lensa US 4 C2 - 5 days ago
Randstad Los Angeles, United Statesgrievance and appeals coordinator (ca residents). · + los angeles , california (remote) · + posted 2 days ago · **job details** · summary · + $ $22 per hour · + temporary · + high school · + category healthcare support occupations · + referenceAB_4523235 · job details · This posi ...
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grievance and appeals coordinator
Found in: Lensa US 4 C2 - 1 day ago
Randstad Los Angeles, United Statesgrievance and appeals coordinator (ca residents). · + los angeles , california (remote) · + posted 6 days ago · **job details** · summary · + $ $22 per hour · + temporary · + high school · + category healthcare support occupations · + referenceAB_4523235 · job details · This posi ...
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grievance and appeals coordinator
Found in: Lensa US 4 C2 - 2 days ago
Randstad Los Angeles, United Statesgrievance and appeals coordinator (ca residents). · + los angeles , california (remote) · + posted 5 days ago · **job details** · summary · + $ $22 per hour · + temporary · + high school · + category healthcare support occupations · + referenceAB_4523235 · job details · This posi ...
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grievance and appeals coordinator
Found in: Lensa US 4 C2 - 4 days ago
Randstad Los Angeles, United Statesgrievance and appeals coordinator (ca residents). · + los angeles , california (remote) · + posted 3 days ago · **job details** · summary · + $ $22 per hour · + temporary · + high school · + category healthcare support occupations · + referenceAB_4523235 · job details · This posi ...
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Grievance and appeals coordinator
Found in: Lensa US 4 C2 - 16 hours ago
Randstad Los Angeles, United StatesThis position requires previous Grievance and Appeals experience. Position is remote but candidates must reside in the state of California. Schedule: Must be available to work an 8 hour shift anytime between 8am-6pm PST Pay rate: $22/hour Work equipment: Will be provided and ship ...
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Grievance and Appeals Coordinator
Found in: Lensa US 4 C2 - 6 days ago
Randstad North America, Inc. Los Angeles, United StatesSpeaki[ " · speaking with healthcare providers and members · utilizing different material and navigating through systems · communicating with internal and external parties · formulating responses in writing to members · " ][ "Experience. Experie Coordinator, Appeals, Administrati ...
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Grievance and Appeals Coordinator
Found in: beBee S2 US - 5 days ago
Randstad USA Los Angeles, United States TEMPORARY, Full timeThis position requires previous Grievance and Appeals experience. Position is remote but candidates must reside in the state of California. Schedule: Must be available to work an 8 hour shift anytime between 8am-6pm PST Pay rate: $22/hour Work equipment: Will be provided and ship ...
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Grievance and Appeals Coordinator 1
Found in: Lensa US 4 C2 - 1 day ago
Workforce Connections Los Angeles, United StatesJob Title:Grievance and Appeals Coordinator 1 · 2 openings · Contract Duration: 6+ mont contract with potential to convert to full-time · Pay Rate: $20-22/hr · Location: Remote/Hybrid - must be local to Woodland Hills, CA (may need to come in for meetings) · Work Hours:M-F a ...
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Grievance & Appeals Coordinator I
Found in: beBee S2 US - 5 days ago
TEKsystems Los Angeles, United States OTHERHiring for Grievance and appeals Coordinator · Tek Systems is currently hiring for Healthcare program coordinators for one of top healthcare company in Florida. · Description: · Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from provide ...
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Appeals and Grievance Coordinator
Found in: Lensa US 4 C2 - 11 hours ago
Imperial Health Plan of California, Inc. Pasadena, United StatesJOB TITLE: · Appeals and Grievance Coordinator · FLSA STATUS: · Non-Exempt · DEPARTMENT: · Appeals and Grievances · REPORTS TO: · Supervisor, Appeals & Grievances · JOB SUMMARY: · Responsible for reviewing and resolving member complaints and appeals and communicating resolu ...
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Appeals and Grievance Coordinator
Found in: Appcast US C2 - 2 days ago
Imperial Health Plan of California, Inc. Pasadena, United StatesJOB TITLE: Appeals and Grievance Coordinator FLSA STATUS: Non-Exempt · DEPARTMENT: Appeals and Grievances · REPORTS TO: Supervisor, Appeals & Grievances · JOB SUMMARY: Responsible for reviewing and resolving member complaints and appeals and communicating resolution to members ...
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Grievance and Appeals Coordinator
Found in: ZipRecruiter Standard US C2 - 4 days ago
Cross Country Workforce Solutions Group Orange, United StatesJob Description · Job DescriptionPosition Summary · Program Assistant · Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent will work independently, exerc ...
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Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: Lensa US 4 C2 - 4 days ago
L.A. Care Health Plan Los Angeles, United StatesUtilization Management/Appeals and Grievances Nurse Specialist RN II · Job Category: Clinical · Department: CSC Appeals & Grievances · Location: · Los Angeles, CA, US, 90017 · Position Type: Full Time · Requisition ID: 10893 · Salary Range: $88, Min.) - $115, Mid.) - $142, Max.) ...
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Appeals and Grievances Manager
Found in: Lensa US 4 C2 - 2 days ago
Imperial Health Plan of California, Inc. Los Angeles, United StatesJOB SUMMARY: Oversees the department work activities assuring compliance with all regulatory guidelines and policy protocols. Serves as the team leader for the team who receives, investigates, and responds to all member grievances & appeals. Responsible for the overall compliance ...
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Senior Employee and Labor Relations Specialist
Found in: Lensa US 4 C2 - 3 days ago
Los Angeles Community College District Office Los Angeles, United StatesDefinition · Plans, organizes, and supervises the day-to-day activities of a small unit engaged in employee and labor relations activities involving disciplinary actions, grievances, appeals, complaints, contract negotiations, and other related areas; personally performs the mor ...
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Quality Compliance Nurse and Compliance Coordinator
Found in: Lensa US 4 C2 - 4 days ago
Preferred IPA of California Los Angeles, United StatesJob Description · Job Description · Openings for both a Quality Compliance Nurse and a Compliance Coordinator. · QUALITY COMPLIANCE NURSE · PURPOSE: · The Quality and Compliance Nurse is responsible for working with the Medical Director, the VP of Clinical Policy, the QM Commi ...
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Labor Relations Manager
Found in: Lensa US 4 C2 - 2 days ago
University of California Los Angeles, United StatesWhen you join UCLA Health, you can make a difference in people's lives every day as you'll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, ...
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Labor Relations Manager
Found in: Lensa US 4 C2 - 2 weeks ago
UCLA Health Los Angeles, United States Full timeWhen you join UCLA Health, you can make a difference in people's lives every day as you'll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, ...
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home department payroll/personnel coordinator i
Found in: MyJobHelper US C2 - 3 days ago
University of Southern California Los Angeles, CA , USA, United StatesHome Department Payroll/Personnel Coordinator IApply \_REQ /apply) Keck School of Medicine Los Angeles, California · HD Payroll/Personnel Coordinator I · Keck School of Medicine · Los Angeles, California · The Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell R ...
Customer Solution Center Appeals and Grievances Coordinator I - Los Angeles, United States - L.A. Care Health Plan
Description
Salary Range: $47, Min.) - $57, Mid.) - $68, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the care management/continuity of care process including intake, logging, tracking and status follow-up.
This position collects information required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by maintaining an accurate database inventory of care management and continuity of care cases, and preparing monthly activity reports.
In addition, the position performs data entry and processing of health risk assessments in the system, maintains confidentiality when communicating member information, and assists with the communication and coordination between programs. Prepares template determination/education letters for members and providers.
Duties
Provide non-clinical support to the Customer Solution Center Appeals and Grievance Specialists for L. A. Care's Medicare Advantage program. This includes the technical aspects of the time sensitive processes for initiating cases, managing referral documentation, entering pre-certification/continued authorizations, identifying and responding to urgency of the request, appropriate documentation, case routing & tracking, routing of information, performing computer data input, faxing, filing of confidential member information, and maintaining logs of activity, etc.). (40%)
Assist in the telephonic outreach calls to members identified during health risk assessments as in needed of care coordination assistance. Consist of follow up calls to members to administer screening or obtaining clarification on initial responses. (25%)
Under the supervision of the Appeals and Grievance Manager, assist with soliciting non-clinical information from Participating Physical Group (PPG) and specialist concerning follow care related to care management. (15%)
Maintain the monthly reporting responsibilities, Appeals and Grievance reporting to Department Director, ongoing referrals and authorizations for members in complex care management. (5%)
Accurately maintain an updated log of L.A. Care members identified as SPD or eligible with CCS cases. If members become ineligible with L.A Care or a specific program members are referred to Member Services for transition to other applicable programs". (5%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Experience
Required:
At least 0-6 months of experience in Medi-Cal managed care authorization processes and/or as a Medical Assistant.
Skills
Required:
Knowledge of medical terminology and ICD-10 and CPT codes.
Strong verbal and written communication skills.
Proficiency with Microsoft Word, Excel, and Access.
Excellent organizational, interpersonal and time management skills.
Must be detail-oriented and an enthusiastic team player.
Knowledge of MHC computer system a plus.
Licenses/Certifications Required
Licenses/Certifications Preferred
Certified Medical Assistant (CMA)
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including