IEHP

Temporary Coordinator - Grievance and Appeals (Short-term assignment)

IEHP  •  Onsite  •  10 days ago
Expired
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Job Description

This is a short-term assignment.

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the general direction of the Grievance & Appeals Nurse Manager and Grievance Supervisor, the Grievance and Appeals Coordinator is responsible for completing administrative functions and supporting departmental activities for processing Grievance and Appeal cases. The Grievance and Appeals Coordinator is responsible for ensuring that IEHP personnel adhere to the guidelines established and outlined in the IEHP Grievance and Appeals Resolution System. The Grievance and Appeals Coordinator exercises independent judgment to ensure appropriate escalation protocols when trends or deficiencies are identified.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Key Responsibilities

  • Maintain working knowledge of regulatory guidelines surrounding Grievances per CMS, DHCS, and DMHC.
  • Understand Member and Provider legal rights to access the Grievance and Appeals Resolution Process, within the respective Provider Organization and IEHP.
  • Ensure compliance with the IEHP Grievance and Appeals Resolution Process, in accordance with all Health Plan regulatory agencies.
  • 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 IEHP Member and Provider grievances and appeals.
  • Generates written correspondence to Providers, Members, and regulatory entities using appropriate grammar and punctuation.
  • Ensure all appropriate grievance and appeal letters are sent out within regulatory compliance guidelines.
  • Assist IEHP personnel in filing, tracking, and closing Member and Provider grievances.
  • When designated to intake cases, the Grievance and Appeals Coordinator will ensure the following:
  • Assign new cases as received for medical urgency and assign to appropriate Grievance Team Member for investigation and resolution.
  • Alert assigned Team Member to any immediate needs, provide guidance regarding depth of investigation, best investigative approach, and manner of documentation, such as close oral case as a “1-day” (no written notification required), obtain verbal or written response from provider as indicated, or resolve internally with no provider input required.
  • Act as a liaison between IEHP departments to coordinate information and close grievances and appeals within regulatory timelines.
  • Keep the Grievance and Appeals Supervisor aware of “open” & “pending” grievance/appeal issues and expected resolution measures.
  • Maintain and prepare grievance and appeals summary reports, as needed.
  • Assist IEHP management in the assessment of grievance and appeal information for the potential change to IEHP policies and procedures.
  • Responsible for working with Team Members to support the protocols and goals of the department and the vision of the organization.
  • Demonstrate a commitment to incorporate LEAN principles into daily work.
  • Speak to health plan members as needed to clarify or obtain any information necessary in order to process a Grievance or an Appeal appropriately.
  • Speak to health plan members as needed to answer any questions regarding their case

    • Qualifications

    Education & Experience

    • Three or more (3+) years of administrative experience in an office environment, including use of Microsoft Office Suite. Demonstrated superior interpersonal and administrative skills commensurate with years of experience
      • Preferred: Experience in a managed care Member Service/Customer Service environment. Prior Medi-Cal and Medicare experience helpful. Previous experience documenting and resolving Member and Provider grievances and appeals
    • High school diploma or GED required
      • Bachelor’s degree from an accredited institution preferred

    Key Qualifications

    • Excellent communication and interpersonal skills
    • Strong organizational skills, typing 45 words per minute, proficient in Microsoft Word and Excel, and data entry experience are essential.
    • Telephone courtesy
    • Ability to handle multiple tasks
    • Strong attention to detail and ability to prioritize work to ensure adherence to task deadlines
    • Ability to learn and follow standards and procedures
    • Positive Attitude and ability to work in a team setting

    Start your journey towards a thriving future with IEHP and apply TODAY!

    Pay Range

    USD $23.98 - USD $23.98 /Hr.

    IEHP

    About IEHP

    With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®. Founded in 1996, IEHP supports more than 1.5 million Riverside and San Bernardino County residents enrolled in Medicaid or IEHP DualChoice (those with both Medi-Cal and Medicare). As of 2024, IEHP also offers Covered California plans, further ensuring health care access for even more IE residents. Today, IEHP has a robust network of quality doctors throughout our two counties and nearly 4,000 team members who are fully committed to the vision: We will not rest until our communities enjoy optimal care and vibrant health. To learn more, go to iehp.org.

    Comprehensive Benefits

    Competitive salary and a benefits package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

    Mission: To heal and inspire the human spirit.

    Vision: We will not rest until our communities enjoy optimal care and vibrant health.

    Values: We do the right thing by: Placing our Members at the center of our universe; unleashing our creativity and courage to improve health and well-being; bringing focus and accountability to our work; and never wavering in our commitment to our Members, Providers, Partners, and each other.

    Winning Team Culture

    Certified as A Great Place To Work® four years in a row.

    Industry
    Healthcare & Social Services
    Company Size
    1,001-5,000 employees
    Headquarters
    Rancho Cucamonga, CA
    Year Founded
    1995
    Website
    iehp.org
    Social Media