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Customer Solution Center Appeal and Grievance
3 months ago
**Customer Solution Center Appeal and Grievance Compliance Advisor**
**Hybrid**
**Position will be hybrid - during audits that are conducted in the year will come on site to collaborate with team. Person must be flexible and ideally live local to Los Angeles. Person must be living in state while working remote.**
**Los Angeles, CA, US**
**Healthcare**
**Job Summary**
The Customer Solution Center Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance of CSC management, a successful auditing strategy for the following end-to-end processes within CSC (i.e. Enrollment processing timeliness and accuracy of loading members, timeliness of I.D. Card and member materials, outbound health risk assessment (HRA) calls for Seniors and People with Disabilities (SPD) and Cal MediConnect (CMC) plus HIF for L.A. Care Medi-Cal Direct program (MCLA), call documentation and categorization, service authorization request and coverage determination, Appeals and Grievances across all lines of business). This position is responsible for the ongoing progression and maintenance of CSC's compliance program efforts, including, but not limited to, policy and procedure development, training and education initiatives, and compliance programmatic developments and enhancements.
**Education Required**
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
**Education PreferredExperience**
**Required**:
A minimum of 5 years experience in regulatory auditing (Appeals & Grievances, Call Center, Enrollment) in a healthcare environment required.
Pay: $88,000.00 - $115,000.00 per year
**Benefits**:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
Application Question(s):
**Experience**:
- Audit or Compliance in Healthcare: 5 years (preferred)
- Appeals & Grievances Audit: 3 years (preferred)
Work Location: Hybrid remote in Los Angeles, CA 90001
