Job Description

Location: Health Choice Management Co.
Posted Date: 9/4/2020

Position Purpose: The Grievance Coordinator processes all quality and non-quality events and surveys from internal and external customers.

Responsibilities:

  • Read, abide by, and demonstrate an understanding of all policies, procedures, contract requirements, and laws that apply to job. Seek clarification from supervisor if ever unclear about a policy, rule, contract provision, or legal obligation.
  • Adhere to HIPAA laws at all times; notify Privacy Officer immediately upon learning of a real or potential breach of protected health information.
  • Complete initial orientation and annual mandatory educational requirements.
  • Participate in quality activities to include: reporting and following up on grievances and complaints, participating in quality/performance improvement projects and accreditation activities.
  • Report grievances accurately and timely
  • Participate in all aspects of the Member Grievance process to include discovery, intake, logging, triage/referral, investigation, case development and presentation at QM and QOC meetings, as requested
  • Monitor the Quality Data base for Provider and facility Member Grievance/QOC Trends, appropriately report to Quality Manager
  • Compile numbers for HCA/HCG/ Reporting requirements
  • Maintain organization within the QOC process
  • Conduct thorough investigation of cases requesting additional documentation, as necessary
  • Ensure timely follow-up, and track the status of cases
  • Provide presentation of cases as needed relating to the QOC process
  • Ensure resolution of QOCs within the HCA/HCG/ policy guidelines
  • Demonstrate accuracy and timeliness in logging incoming matters into the QOC database
  • Demonstrate compliance with HCA/HCG/ policies and regulatory agencies
  • Data and respective reports are complete, accurate, and timely
  • Confidentiality is maintained on all files, investigation, and results of quality of care issues
  • Maintain a Monthly Log / Agenda for these meetings, which outline the more serious issues that occur during the month
  • Maintain an open line of communication between Transportation Leads in Member Services and MTBA Management Staff
  • Familiarize new Member Services Representatives with QM and complaint process- providing materials and question and answer period
  • Data and respective reports are complete, accurate, and timely
  • Frequent communication with the Grievance Manager and/or the Sr. Quality Management Director and other personnel/departments facilitates opportunities to identify and implement process improvements

Education / Experience / Other Requirements

Education:

  • High School Diploma or G.E.D.

Years of Experience:

  • 2 years of customer service and/or provider relations experience
  • Medicare and/or Medicaid experience

Specialized Knowledge:

  • Computer experience necessary, Microsoft products, database
  • Effective time management skills
  • Effective interpersonal and communication skills, including communication on the phone
  • Ability to compose correspondence
  • Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified timeframes
  • Bilingual Spanish-English, preferred
  • Ability to compose correspondence
  • Ability to carry out written and oral instructions
  • Problem solving abilities
  • Work cooperatively, positively, and collaboratively in an interdisciplinary team
  • Work respectfully and positively with members

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online