Program Assistant (GARS)
The Judge Group Inc.

Job Info

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Location: Orange, CA
Description: Our client is currently seeking a Program Assistant (GARS)

Under general supervision, the incumbent will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent will work independently, exercising discretion and judgment and may assist in coordinating a function for the program assigned. Primary responsibilities include monitoring the GARS mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe. Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax, or via email from the website for members and providers. •Monitors for inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) 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). •Responds to the DMHC on requests for information timely. •Works with internal and external departments and providers in gathering supporting information relevant to the case. •Sets up complaint case files, enter cases in the GARS system with accurate classification and category types and assigns to appropriate staff. •Generates acknowledgement letters for all lines of business per department and regulatory standards. •Assists in the development of departmental forms and intake process. •Coordinates administrative support for State Hearings including serving as contact with State Department Social Services for incoming cases, entering cases in the GARS system, creating electronic file and routing the scanned documents to designated staff and faxing required State Hearing documentation to local hearing office as necessary. •Other projects and duties as assigned. Possesses the Ability To: •Provide professional support to managers and staff in program to which assigned. •Coordinate multiple administrative activities. •Work on specialized process or function to which assigned. •Communicate clearly and concisely, both verbally and in writing with internal and external contacts. •Effectively utilize computer and appropriate software (e.g. Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems applicable to the assignment. Experience & Education •High school diploma or equivalent required. •1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs highly desirable. •Bilingual in English is preferred. Knowledge of: •Services, policies and general responsibilities of program to which assigned. •Practices and techniques required to function with professions working in assigned program. •Methods and techniques for organizing and implementing processes. •General information relevant to professional or administrative responsibilities in assigned program.

Make it a great day!

Tiffany Rutkoske, National Healthcare Recruiter, The Judge Group

16795 Von Karman Avenue Suite 200

Irvine, CA. 92606

Office/ Fax : (949)527-4557 ext. 2834 | Text: (484) 585-4372

trutkoske@judge.com|judge.com|linkedin.com/in/tiffany-rutkoske-a2330b7a

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Contact: trutkoske@judge.com

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