Grievance and Appeals Coordinator
1 month ago
Grievance and Appeals Coordinator
75 Vanderbilt Ave, Staten Island, NY 10304, USA
Req #660
Wednesday, June 5, 2024
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
JOB SUMMARY:
As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related grievances and appeals across CPHLs various lines of business. Process includes gathering, documenting, tracking, and pursuing resolution of complaints in accordance with regulatory and organizational guidelines to the members satisfaction.
PRIMARY RESPONSIBILITIES:
+ Logs and tracks verbal or written member grievances and appeals.
+ Conducts relevant research into complaints and collaborates, coordinates and communicates with various departments (i.e. Member Services, Care Management, Claims), as well as external entities (i.e. Providers and Vendors) to collect additional information as necessary.
+ Maintains a current knowledge of plan products, policies and procedures with the ability to relate acquired knowledge in a clear, concise and understandable manner to members, providers, and internal staff.
+ Ensures grievances and appeals are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy.
+ Prepares, generates, and mails letters, forms, and other G&A-related notices.
+ Maintains confidentiality of all protected health information in accordance with state, federal, and corporate guidelines.
+ Performs other duties as assigned
Qualifications:
Education
High school diploma or equivalent required. Associates Degree preferred
Experience
Minimum two years of experience in customer service or health service environment. Previous experience in Managed Care grievances/appeals preferred. Strong communication, organizational, critical thinking, and problem solving skills.
Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.
Other details
+ Pay Type Hourly
+ Min Hiring Rate $20.51
+ Max Hiring Rate $21.54
Apply Now
+ 75 Vanderbilt Ave, Staten Island, NY 10304, USA
We have other current jobs related to this field that you can find below
-
Care Coordinator
2 weeks ago
Staten Island, United States The Jewish Board of Children and Family Services Full timeMake a bigger difference WORKING WITH US At The Jewish Board, we don't just make a difference - we make a bigger difference as we serve 45,000 New Yorkers every year. Join our dedicated team that's been helping communities across New York City for almost 150 years and see just how big of a difference you can make. IF YOU JOIN US, YOU'LL HAVE THESE GREAT...
-
Registered Field Nurse
2 months ago
Staten Island, United States Fadmo Health and Home Care Full time $115,000 - $125,000Field Registered Nurse (Home Health Care)Specialties: Home HealthFadmo Health careFadmo's Field Registered RN's are responsible for the initial evaluations as well as re-assessments of our home care clients. This offers you the ability to build lasting relationships with clients and their families. The Field Registered Nurse is responsible for the...
-
Case Manager
2 months ago
Staten Island, United States Women In Need Full timeTitle of Position: Case Manager Department: Transitional Housing FLSA Status: Non-Exempt Reports to: Social Service SupervisorSalary: $24.49 per hour Positions reporting to this position: NonePurpose of the Position: The Case Manager is responsible for case management services for clients in transitional housing. The Case Manager will have an assigned...
-
Staten Island, United States Doral Medical and Multispecialty Facility LLC Full timeA Growing Homecare Company is currently seeking compassionate and experienced Nurse Practitioners to do home visits for our patients in all boroughs especially Staten Island.Our goal is to provide superior, compassionate home care workers and healthcare services for elderly and disabled individuals in the comfort and dignity of their homes. We work closely...
-
Event Coordinator
4 weeks ago
Pawleys Island, United States Senior Living Communities Full timeFind your new career with a team of HEROES, who are ordinary people doing extraordinary things for seniors. We are dedicated to giving back and supporting our team members, local community, and others worldwide. Come join a team with (6) Industry Best of the Best Awards and help us put People First, Always. The Lakes at Litchfield is now accepting...
-
Social Worker
2 months ago
Staten Island, United States Jewish Board of Family and Children's Services Full timeSocial Worker (Licensed) 1765 South Ave, Staten Island, NY 10314, USA ReqMake a bigger difference Fee-For-Service Therapist (Hybrid Telehealth/In-Person Role): $1,000 SIGNING BONUS At The Jewish Board, we don't just make a difference - we make a bigger difference as we serve 45,000 New Yorkers every year. Join our dedicated team that's been helping...
-
Social Worker
2 months ago
Staten Island, United States The Jewish Board of Children and Family Services Full timeMake a bigger difference Fee-For-Service Therapist (Hybrid Telehealth/In-Person Role): $1,000 SIGNING BONUS At The Jewish Board, we don't just make a difference - we make a bigger difference as we serve 45,000 New Yorkers every year. Join our dedicated team that's been helping communities across New York City for almost 150 years and see just how big of a...
-
Interim Development Coordinator
2 weeks ago
Bainbridge Island, United States Bloedel Reserve Full timeJob DescriptionJob DescriptionSalary: $24 - 26.50 per hourThe Development Coordinator maximizes the efficiency and effectiveness of Bloedel Reserve’s fundraising operations. Responsible for administering the Development department’s systems, policies, procedures, and timelines necessary for operational success. Works closely with members of the...
-
Interim Development Coordinator
2 weeks ago
Bainbridge Island, United States Bloedel Reserve Full timeJob DescriptionJob DescriptionSalary: $24 - 26.50 per hourThe Development Coordinator maximizes the efficiency and effectiveness of Bloedel Reserve’s fundraising operations. Responsible for administering the Development department’s systems, policies, procedures, and timelines necessary for operational success. Works closely with members of the...
-
Therapist Staten Island CPP
2 weeks ago
Staten Island, United States The Jewish Board of Children and Family Services Full timeMake a bigger difference WORKING WITH US At The Jewish Board, we don't just make a difference - we make a bigger difference As we serve 45,000 New Yorkers every year. Join our dedicated team that's been helping communities across New York City for almost 150 years and see just how big of a difference you can make. Sign-on Bonus If you join us, you'll have...
-
Social Services Assistant
3 weeks ago
Grand Island, United States Tiffany Square Full timeJob DescriptionJob DescriptionJoin our Team: Make a Difference in the Lives of Our Elders as a Social Services Assistant!Position Purpose: Through the development of a strong personal relationship, provide an atmosphere that promotes comfort, safety, a sense of well-being and above all, dignity in life, while providing excellent social service services that...
-
Social Worker
2 months ago
Staten Island, United States The Jewish Board of Children and Family Services Full timeMake a bigger difference At The Jewish Board, we don't just make a difference - we make a bigger difference as we serve 45,000 New Yorkers every year. Join our dedicated team that's been helping communities across New York City for almost 150 years and see just how big of a difference you can make. Reasons you'll love working with us: If you have a...
-
Family Advocate P/T
2 months ago
Staten Island, United States The Jewish Board of Children and Family Services Full timeMake a bigger difference WORKING WITH US At The Jewish Board, we don't just make a difference - we make a bigger difference As we serve 45,000 New Yorkers every year. Join our dedicated team that's been helping communities across New York City for almost 150 years and see just how big of a difference you can make. IF YOU JOIN US, YOU'LL HAVE THESE GREAT...
-
Lead Cook
2 months ago
Grand Island, United States Good Samaritan Society Full timeGood Samaritan Society - 4075 Timberline St [Kitchen Staff / Grill Cook / Line Cook] As a Cook at Good Samaritan Society, you'll: Coordinate production, prepare and serve nutritious, appealing meals to residents following orders, standards, and regulations; Assist with development of pleasing and unique recipes and menu creation; Maintain continuous quality...
-
Lead Cook
2 months ago
Grand Island, United States Good Samaritan Society Full timeGood Samaritan Society - 4075 Timberline St [Kitchen Staff / Grill Cook / Line Cook] As a Cook at Good Samaritan Society, you'll: Coordinate production, prepare and serve nutritious, appealing meals to residents following orders, standards, and regulations; Assist with development of pleasing and unique recipes and menu creation; Maintain continuous quality...
-
Care Transition Coordinator
1 week ago
Merritt Island, United States Solaris HealthCare Merritt Island Full timeCome join our 5-star quality measure, Joint Commission accredited, best-in-area rated facility! Our team mission is to foster the best care in the area for our patients, while providing an environment where our team can thrive and succeed in their career. RN/LPN license preferred, but not required. The ideal candidate will have strong experience in community...
-
J Kids Coordinator
2 months ago
Mercer Island, United States Samuel and Althea Stroum Jewish Community Center Full timeJob Type Full-time Description Enjoy having fun with children, teens, and adults? Join the J Kids and J Camp team! The J Kids Coordinator and Assistant Camp Director oversees afterschool programs, enrichment classes, and Parents Night Out programs, and works closely with the Camp Director to run Summer J Camp and School's Out Camps at the Stroum Jewish...
-
Warehouse Worker/Delivery Driver
3 weeks ago
Grand Island, United States Slumberland Furniture Full time $17 - $19Slumberland Furniture is looking to hire a Warehouse Worker/Delivery Driver.Slumberland is a local family-owned and operated business. We pride ourselves on providing a fun, flexible, and rewarding working environment. We offer competitive wages with opportunities for growth, as well as an appealing benefits package that goes beyond the basics. If you are...
-
Chief Talent Officer
45 minutes ago
Long Island City, United States Grand Street Settlement Full timeTITLE: Chief Talent Officer Make your application after reading the following skill and qualification requirements for this position. LOCATION: New York, NY (Lower East Side) DEPARTMENT: Administration/Human Resources REPORTS TO: Chief Executive Officer (CEO) SALARY RANGE: $175,000 to $200,000 annually depending on experience, plus excellent benefits DATE...
-
J Kids Coordinator
4 weeks ago
Mercer Island, United States SAMUEL AND ALTHEA STROUM JEWISH COMMUNITY CENTER O Full timeJob DescriptionJob DescriptionDescription:Enjoy having fun with children, teens, and adults? Join the J Kids and J Camp team! The J Kids Coordinator and Assistant Camp Director oversees afterschool programs, enrichment classes, and Parents Night Out programs, and works closely with the Camp Director to run Summer J Camp and School's Out Camps at the...
