Grievance and Appeal Intake Coordinator - Denver Health Medical Plan (Must Be a Colorado Resident)
Grievance and Appeal Intake Coordinator - Denver Health Medical Plan (Must Be a Colorado Resident)
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Job Description
We are here for lifes journey.
Where is your life journey taking you
Being the heartbeat of Denver means our heart reflects something bigger than ourselves something that connects us all:
Humanity in action Triumph in hardship Transformation in health.
Department
Managed Care AdministrationMust Be a Colorado Resident
Job Summary
The Grievance and Appeal Intake Coordinator (Coordinator) works under general supervision and supports the G&A team through gathering grievances and appeals from the SharePoint log portal submissions email phone and fax inputting complaint and appeal requests within the G & A software platform. Answers the G & A phone line providing information and assistance.
Essential Functions:
- Processes incoming submissions either by fax phone email portal or SharePoint Log (40%)
- Responds to all G&A requests including alignment with plan benefits structure enrollment policies and compliance requirements Communicates in a HIPAA-compliant and professional manner (20%)
- Answers incoming provider and member calls regarding complaints and appeals. (10%)
- Completes documentation of G&A activities in accordance with departmental procedures and in compliance with NCQA and CMS standards. (10%)
- Assigns cases to the Grievance and Appeals Specialist (5%)
- Identifies urgent requests and routes them accordingly (5%)
- Educates the provider with documentation that is needed to submit requests (5%)
- Generates and sends approved Acknowledgment letters within approved scope (5%)
Education:
- High School Diploma or GED required
Work Experience:
- 1-3 years customer service or clerical/administrative experience required
Licenses:
Knowledge Skills and Abilities:
- Bilingual preferably in Spanish
- Strong attention to detail
- Ability to communicate effectively both in writing and verbally has superior decision making and problem solving skills
- Ability to use a variety of software programs including Microsoft Office claims payer and medical management systems
- Experience with Windows-based computer programs and ability to use computer for data analysis and data display required
Must Be a Colorado Resident
Shift
Days (United States of America)Work Type
RegularSalary
$22.88 - $32.03 / hrBenefits
Outstanding benefits including up to 27 paid days off per year immediate retirement plan employer contribution up to 9.5% and generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands travel and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
Respect
Belonging
Accountability
Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test once a conditional offer of employment has been made.
Denver Health is an integrated high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center a 555-bed acute care medical center Denvers 911 emergency medical response system 10 family health centers 19 school-based health centers Rocky Mountain Poison & Drug Safety a Public Health Institute an HMO and The Denver Health Foundation.
As Colorados primary and essential safety-net institution Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community focusing on hiring and purchasing locally as applicable serving as a pillar for community needs and caring for more than 185000 individuals and 67000 children a year.
Located near downtown Denver Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas talents and contributions reflective of the needs of our community.
Applicants will be considered until the position is filled.
Required Experience:
IC
Employment Type
Full-Time
