Grievance and Appeals Coordinator

4 weeks ago


Fremont, California, United States A-Line Staffing Solutions Full time
Job Title: Grievance and Appeals Coordinator

We are seeking a highly organized and detail-oriented Grievance and Appeals Coordinator to join our team at A-Line Staffing Solutions.

Job Summary:

The Grievance and Appeals Coordinator will be responsible for thoroughly documenting the investigation and resolution of each case, maintaining accurate and complete appeals/grievance records, and coordinating the Alliance component of the State Fair Hearing, MAXIMUS, Independent Medical Review (IMR), and DMHC appeal processes.

Key Responsibilities:
  • Document and track all grievances and appeals in a timely and accurate manner.
  • Coordinate and prepare the Alliance component of the State Fair Hearing, MAXIMUS, IMR, and DMHC appeal processes.
  • Ensure compliance with state and federal regulations as they relate to appeal and grievance issues.
  • Serve as a liaison with other departments to resolve grievance issues.
  • Ensure timely communication with the Supervisor on all issues having potential risk and/or impact on operations.
  • Engage in special projects as assigned/requested.
Requirements:
  • High School Diploma or GED.
  • Minimum of one to two years of experience in health services, managed care, hospital, or similar setting.
  • Knowledge of managed care and medical terminology.
  • Excellent verbal and written communication skills.
  • Strong organizational skills.
  • Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint.
Preferred Qualifications:
  • Associates and/or bachelor's degree.
  • Minimum of one to two years of experience in health services, managed care, hospital, or similar setting.

We offer a competitive compensation package, including a salary range of $29.10-$35 per hour based on experience, and benefits available to full-time employees after 90 days of employment.

If you are a motivated and detail-oriented individual with a passion for healthcare and dispute resolution, we encourage you to apply for this exciting opportunity.



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