- Quality/Process Improvement/Safety
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Appeals and Grievance Coordinator
1 week 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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Appeals and Grievance Coordinator
1 week 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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Appeals and Grievance Coordinator
1 week ago
Imperial Health Plan of California, Inc. Los Angeles, 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
1 day ago
Randstad Los Angeles, United StatesA trusted client of Randstad's has openings for experienced Grievance and Appeals Coordinators. Must be experienced with grievance and appeals, claim denials, medical terminology and CPT codes. Previous Grievance and Appeals experience preferred. Ability to communicate with provi ...
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grievance and appeals coordinator
2 weeks 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
2 weeks 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
2 weeks 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
1 week ago
Randstad North America, Inc. Los Angeles, United StatesSpeaki[ " · \tspeaking with healthcare providers and members · \tutilizing different material and navigating through systems · \tcommunicating with internal and external parties · \tformulating responses in writing to members · " ][ "Experience. Experie Coordinator, Appeals, Admi ...
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Grievance and Appeals Coordinator
2 weeks 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 week 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
1 week ago
Randstad North America, Inc. Woodland Hills, United StatesA trusted client of Randstad's has openings for experienced Grievance and Appeals Coordinators. Must be experienced with grievance and appeals, claim denials, medical terminology and CPT codes. Previous Grievance and Appeals experience preferred. Abi Appeals, Coordinator, Adminis ...
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Grievance and appeals coordinator
6 days ago
Randstad Woodland Hills, United StatesA trusted client of Randstad's has openings for experienced Grievance and Appeals Coordinators. Must be experienced with grievance and appeals, claim denials, medical terminology and CPT codes. Previous Grievance and Appeals experience preferred. Ability to communicate with provi ...
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Grievance and Appeals Coordinator
1 week ago
Randstad USA Woodland Hills, United States TEMPORARY, Full timeA trusted client of Randstad's has openings for experienced Grievance and Appeals Coordinators. Must be experienced with grievance and appeals, claim denials, medical terminology and CPT codes. Previous Grievance and Appeals experience preferred. Ability to communicate with provi ...
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Grievance & Appeals Coordinator I
7 hours ago
Centene Corporation Los Angeles, United StatesYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...
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Grievance and Appeals Coordinator 1
1 week ago
Workforce Connections Los Angeles, United StatesJob Title:Grievance and Appeals Coordinator 12 openingsContract Duration: 6+ mont contract with potential to convert to full-timePay Rate: $20-22/hrLocation: Remote/Hybrid - must be local to Woodland Hills, CA (may need to come in for meetings)Work Hours:M-F anywhere between 8am- ...
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Grievance and Appeals Coordinator 1
4 days 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
1 week 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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Grievance & Appeals Coordinator I
1 day ago
Centene Corporation Woodland Hills, United StatesAnalyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals. Prep Appeals, Coordinator, Adminis ...
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Grievance & Appeals Coordinator I
4 days ago
Centene Corporation Woodland Hills, United States Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...
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Kaiser Permanente Pasadena, United States**Job Summary**: · **Essential Responsibilities**: · - Accomplishes assigned daily management functions of the regional coding operations department, in order to ensure the quality of coded patient records through performing, reviewing and assisting with coder education, audits a ...
Appeals and Grievance Coordinator - Pasadena, United States - Imperial Health Plan of California, Inc.
Description
JOB 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 in accordance with the standards and requirements established by Medicare and applicable state insurance regulations for the Exchange.
ESSENTIAL JOB FUNCTIONS:
Responsible for providing administrative support to ensure grievance and appeal cases are processed per regulatory guideline and internal department protocol including:
Coordinate, document and track all members, grievances and member and provider appeals and or grievances.
Generates written correspondence to members and providers and using appropriate grammar and punctuation.
Ensure all grievance and appeal communications are sent out within regulatory compliance guidelines.
Researches issues utilizing internal systems, outreach to providers, vendors and internal departments in order to fully respond to all issues raised in a grievance or to resolve appeal.
Requests medical records, clinical notes, and responses from providers, vendors and internal departments as needed.Maintains working knowledge of regulatory guidelines surrounding grievances and appeals per Medicare and state regulations and per internal A & G policies & procedures.
Acts as a liaison between departments to coordinate information and close grievances and appeals within regulatory timelines.Keeps A & G leadership aware of "open' & "pending" grievance and appeal cases and expected resolution measures.
Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
Maintains regular and consistent attendance.
Adheres to Compliance Plan and HIPAA regulations.
MARGINAL JOB FUNCTIONS:
Takes on special projects as needed.
Performs other duties as assigned.
BEHAVIORAL EXPECTATIONS:
Continuous Learning:
a. Attends staff meetings as required.
b. Attends appropriate training, seminars and workshops as required.
Customer Focus:
a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations
and IMAS's Standards of Conduct.
b. Fosters appropriate communication and relations with Supervisor, co-workers, and other staff.
b. Supports and demonstrates safety throughout all duties performed.
c. Follows established policies and procedures and understands and complies with all regulators
standards set forth by governing entities.
POSITION REQUIREMENTS:
EDUCATION/EXPERIENCE:
High school graduate or equivalent.
1 year of Medicare A&G experience required.
Must have experience in making outgoing phone calls as well as taking incoming phone inquiries
SKILLS/KNOWLEDGE/ABILITY:
Proficiency with Microsoft Office Suite:
Word, Excel, Outlook, and Power Point.
Solid ability to prioritize tasks and manage multiple tasks simultaneously.
Ability to read, write, speak, and understand English proficiently.
Exercises excellent written, verbal, listening and interpersonal communication skills necessary to effectively interact with all levels of internal and external parties, to convey information correctly, and manage challenging situations.
Strong attention to quality and detail.Excellent communication skills necessary to provide accurate information to members and collaborating staff.
Ability to analyze information provided.
Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
Adheres to maintaining high level of confidentiality and privacy.
Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
Willingness and ability to take initiative and be a self-starter.Willingness and ability to understand and comply with Federal, State, and local regulations.
LICENSURE/CERTIFICATE/TRAINING:
n/a
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