Grievance Coordinator

Are you ready for new challenges and new opportunities?Join our team!AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all.The Culture:AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication, and a generous benefits package.Position Summary of a Grievance Coordinator:The Grievance Coordinator is a key member of the Appeals and Grievance team, ensuring AlohaCare members and providers receive compliant, ethical, and timely resolution of their grievance or appeal. The Grievance Coordinator strives toward excellent customer service, objective research, clear documentation, and responsiveness to our concerned members or providers.Primary Duties & Responsibilities of a Grievance Coordinator:Reviews, researches, and directs complaints, grievances, and appeal cases to appropriate staff, and follows up to ensure resolution has occurred, documentation is complete, required timeframes are met, and proper written communication of the decision has occurred.Maintains grievance and appeal logs in a timely manner for both lines of business, including logging incoming grievances, tracking dispositions, and maintaining timeliness of resolution as required by state and federal mandates.Maintains electronic files of all documentation and appropriate follow-up documentation in member and provider memo screens or other computer system modules as per current workflows.Ensures that all information to providers, members, employees, and other appropriate persons is accurate, consistent, and customer sensitive.Prepares summaries for committee review, documents meeting discussions, and communicates decisions in writing as needed for specific grievances or appeals.Prepares all Grievance & Appeals reports as required by QUEST Integration, CMS, or other regulatory agencies per specified formats and timeframes.Participates in internal committee and interdisciplinary meetings, reporting recent activity and analysis of trends, and makes recommendations for problem resolution and performance improvement.Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies and state and federal laws.Required Qualifications of a Grievance Coordinator:Associate’s degree or equivalent combination of education and experience.1 - 2 years of related work experience.Demonstrates an appropriate level of verbal and written communication in English.Requires operation of general office equipment and working knowledge of Microsoft Office tools.Ability to multi-task, adapt to changing priorities, and manage a diversity of high-priority projects in a fast-paced environment.Demonstrates skills in problem-solving and customer service.Engages in Process Improvement.Preferred Qualifications of a Grievance Coordinator:Bachelor’s Degree.Knowledge of Medicaid, Hawaii QUEST Integration Program, and/or Medicare.Grievance & Appeal processing experience.Physical Demands/Working Conditions:Inside working conditions.Sedentary work: Exerting up to 20 pounds of force occasionally.Salary Range: $17.00 - $22.75 an hour.AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws.

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