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Customer Solution Center Appeals And Grievances Coordinator I
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$47,840 - $68,474 a year
Full-time
- The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the care management/continuity of care process including intake, logging, tracking and status follow-up.
- This position collects information required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by maintaining an accurate database inventory of care management and continuity of care cases, and preparing monthly activity reports.
- Provide non-clinical support to the Customer Solution Center Appeals and Grievance Specialists for L. A. Care's Medicare Advantage program.
- This includes the technical aspects of the time sensitive processes for initiating cases, managing referral documentation, entering pre-certification/continued authorizations, identifying and responding to urgency of the request, appropriate documentation, case routing & tracking, routing of information, performing computer data input, faxing, filing of confidential member information, and maintaining logs of activity, etc
- Under the supervision of the Appeals and Grievance Manager, assist with soliciting non-clinical information from Participating Physical Group (PPG) and specialist concerning follow care related to care management.
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