Grievance Coordinator
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Job Location:
Somerville, NJ - USA
Hourly Salary:
$ 30 - 43
Posted on:
18 hours ago
Vacancies:
1 Vacancy
Job Summary
Site: Mass General Brigham Health Plan Holding Company Inc.
Our work centers on creating an exceptional member experience a commitment that starts with our employees.
We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
The Grievance Coordinator will coordinate process investigate and document all aspects of member complaints and grievances across all our product offerings (Commercial Medicaid and Medicare OneCare/Senior Care Options).
This role will be responsible for documenting and guiding the life cycle of all member grievances. This includes but is not limited to maintaining tracking information working closely with internal stakeholders and external vendors/partners to quickly resolve cases communicating orally and/or in writing to all involved parties during the grievances process and documenting according to established standards for reporting and analysis purposes.
The Grievance Coordinator must have detailed knowledge of all applicable health plan policies and procedures. Regulatory (CMS DOI MassHealth) and contractual requirements knowledge and expertise are key elements of this role. Strong customer service and interpersonal skills are mandatory during regular interactions with customers providers and external agencies.
Principal Duties and Responsibilities:
Handle a large volume of incoming grievances (both formal and informal) from receipt through resolution ensuring that all grievances are resolved within contractual and regulatory timeframes. Ensure accurate time management of all work ensuring results are met on time with high-quality standards
Document and supervise all grievances in the appropriate tracking systems ensuring the highest quality and accuracy of work.
Ensure grievance files are complete and contain all relevant documentation including research materials acknowledgment and resolution letters and any other pertinent information related to the case.
Collaborate with key departments on all grievances including Compliance Pharmacy Medical Directors Sales and other relevant senior and executive staff.
Assists with or is lead on external grievance investigation from regulatory agencies including CMS EOHHS and the Division of Insurance
Assists with preparing formal written responses to external regulators
Work independently with members on their grievances. Provide effective and appropriate information on an ongoing basis to members as you resolve their issues.
Aid in the preparation of reports to various collaborators and provide feedback on ways in which reporting can be enhanced and improved.
Stay ahead of any changes to health plan policies and procedures and work closely with key partners on ensuring that the files being prepared for external agencies are accurate well-written and meet the needs of all parties. Participate in team meetings and other development work ensuring that information is presented accurately and your contribution to any development projects is notable.
Participate in internal and external audits and be receptive to any feedback and training being offered.
Ability to function and excel in a remote environment handling time-critical appeals and grievance cases.
Hold self and others accountable to meet commitments.
Ensure diversity equity and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build positive relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
Other duties as assigned with or without accommodation.Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience a commitment that starts with our employees.
We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
The Grievance Coordinator will coordinate process investigate and document all aspects of member complaints and grievances across all our product offerings (Commercial Medicaid and Medicare OneCare/Senior Care Options).
This role will be responsible for documenting and guiding the life cycle of all member grievances. This includes but is not limited to maintaining tracking information working closely with internal stakeholders and external vendors/partners to quickly resolve cases communicating orally and/or in writing to all involved parties during the grievances process and documenting according to established standards for reporting and analysis purposes.
The Grievance Coordinator must have detailed knowledge of all applicable health plan policies and procedures. Regulatory (CMS DOI MassHealth) and contractual requirements knowledge and expertise are key elements of this role. Strong customer service and interpersonal skills are mandatory during regular interactions with customers providers and external agencies.
Principal Duties and Responsibilities:
Handle a large volume of incoming grievances (both formal and informal) from receipt through resolution ensuring that all grievances are resolved within contractual and regulatory timeframes. Ensure accurate time management of all work ensuring results are met on time with high-quality standards
Document and supervise all grievances in the appropriate tracking systems ensuring the highest quality and accuracy of work.
Ensure grievance files are complete and contain all relevant documentation including research materials acknowledgment and resolution letters and any other pertinent information related to the case.
Collaborate with key departments on all grievances including Compliance Pharmacy Medical Directors Sales and other relevant senior and executive staff.
Assists with or is lead on external grievance investigation from regulatory agencies including CMS EOHHS and the Division of Insurance
Assists with preparing formal written responses to external regulators
Work independently with members on their grievances. Provide effective and appropriate information on an ongoing basis to members as you resolve their issues.
Aid in the preparation of reports to various collaborators and provide feedback on ways in which reporting can be enhanced and improved.
Stay ahead of any changes to health plan policies and procedures and work closely with key partners on ensuring that the files being prepared for external agencies are accurate well-written and meet the needs of all parties. Participate in team meetings and other development work ensuring that information is presented accurately and your contribution to any development projects is notable.
Participate in internal and external audits and be receptive to any feedback and training being offered.
Ability to function and excel in a remote environment handling time-critical appeals and grievance cases.
Hold self and others accountable to meet commitments.
Ensure diversity equity and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build positive relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
Other duties as assigned with or without accommodation.
Qualifications
Education
Bachelors Degree preferred
Experience
- At least 3-5 years of health plan experience ideally within customer service quality or appeals and grievances areas preferred
- Experience leading appeals and grievances for Commercial Medicaid and Medicare products and plans is highly preferred
- Bilingual a plus
Knowledge Skills and Abilities
- Strong aptitude for technology-based solutions.
- Strong customer service skills.
- Excellent communication skills.
- Ability to adapt to changing priorities and work effectively in a dynamic environment.
- Excellent organizational abilities to manage multiple tasks prioritize work and meet deadlines.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$30.00 - $43.63/HourlyGrade
6EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Key Skills
- Corporate Risk Management
- Electronics
- Infection Control
- Bakery
- ELV
- Accident Investigation
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
