Grievance and Appeals Assistant
Kforce Inc.
Job Info
RESPONSIBILITIES:
Kforce healthcare client in Orange, CA that is seeking several Grievance and Appeals Assistants.Responsibilities:- Serves as point of contact for inquiries related to grievances and appeals
- Monitors incoming complaints via mail, telephone, fax or via email from members and providers
- Monitor and respond to requests for information from the Department of Managed Health Care, Medicare Complaint Tracking Module from the Centers for Medicare Medicaid Services (CMS), the Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS)
- Work with internal and external departments and providers in gathering supporting information relevant to the case
- Create complaint case files and enter cases in the system with accurate classification and category types and assign to appropriate staff
- Generate acknowledgment letters for all lines of business per department and regulatory standards
REQUIREMENTS:
- High School diploma/GED required
- 1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs required
- Bilingual preferred
The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.
We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.
Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.
This job is not eligible for bonuses, incentives or commissions.
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
This job has expired.
Get Hired Faster
Subscribe to job alerts and upload your resume!
*By registering with our site, you agree to our
Terms and Privacy Policy.