Appeals And Grievances Coordinator 24-83

We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Job Description:

PURPOSE:

Coordinate the appeals and grievance process by case intake, prep, response outreach and response tracking. This role supports the Appeals and Grievance analyst.

ESSENTIAL RESPONSIBILITIES

• Monitoring of all incoming faxes via electronic fax system (Biscom), determining appropriate action.

• Perform administrative process for all member appeals in Epic authorization system (Tapestry) in accordance with health plan designated time frames (case intake, practice outreach for clinical documentation).

• Determine urgency of claims & grievance and appropriate routing for response.

• Performs administrative processes for all member complaints in electronic customer relationship management system (Salesforce) in accordance with health plan designated time frames (case intake, prep, practice outreach, practice response tracking).

• Monitoring of all Appeals and Grievance email communications.

• Monitoring of all Appeals and Grievance phone calls and voicemails.

• Processing of all grievance notifications received via patient satisfaction survey system, escalate as appropriate.

• Collaborate with internal teams and practices for coordination of all report requests.

• Monitoring of customer relationship management (CRM) Appeals and Grievances que via Epic authorization system (Tapestry).

• Identify opportunities to improve workflows.

• Special cross functional projects as assigned.

• Manage departmental supply orders.

• Other administrative duties as assigned.

NON-ESSENTIAL RESPONSIBILITIES:

• Establish and maintain effective lines of interdepartmental communication.

• Establish and maintain effective lines of communication with outside business partners such as health plans, regulatory bodies, and providers.

SKILLS AND EXPERIENCE REQUIRED:

• Minimum years of experience required: 2-3 years in related managed care experience, experience with appeals and grievances strongly preferred.

• Minimum level of education required: AA, bachelor's degree, or equivalent experience.

• Familiarity of HER including Epic/Tapestry and CRM, Salesforce knowledge strongly preferred.

• Ability to work independently as well as in a team environment.

• Computer experience; high proficiency in Word and Excel.

• Ability to coordinate effectively with team and meet critical project deadlines.

• Excellent organizational and communication skills, both written and oral.

Hourly Range:

$29.34 - 32.99 USD Hourly

This is a Hybrid position

Hill Physicians is an Equal Opportunity Employer