Grievance and Appeals Coordinator

$47,840 - $47,840/Yr

State of California - Orange, CA

Full-time - Entry Level

Orange, CA

Executive, Legislative, and Other General Government Support

About the position

The Grievance and Appeals Coordinator plays a crucial role in managing and responding to grievances and appeals within the healthcare system. This position focuses on providing high-quality customer service and ensuring compliance with regulatory standards while supporting the department's goals and priorities.

Responsibilities

• Participates in a mission-driven culture of high-quality performance with a focus on customer service.
• Serves as the point of contact for inquiries related to grievances and appeals.
• Monitors incoming complaints via various channels including mail, telephone, and email.
• Responds to requests from the Department of Managed Health Care (DMHC) and other regulatory bodies in a timely manner.
• Sets up complaint case files and enters cases into the GARS system accurately.
• Generates acknowledgment letters for all lines of business per department standards.
• Coordinates administrative support for state hearings and manages documentation.
• Assists in the development of departmental forms and intake processes.
• Completes other projects and duties as assigned.

Requirements

• High School diploma or equivalent required.
• 1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs required.
• An equivalent combination of education and experience may also be qualifying.

Nice-to-haves

• Bilingual in English and one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

Benefits

• Contract position with a pay rate of $23.00 per hour.
• Day shift schedule from Monday to Friday.