Appeals & Grievances Coordinator II

Exemption Status:United States of America (Non-Exempt)$39,603 - $51,001 - $62,379"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."This position is not eligible for Sponsorship.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!Job DescriptionSummary:The Appeals and Grievance (A&G) team manages all aspects of Appeals and Grievances processing including, but not limited to, intake, processing, notification, and compliance. This position, Appeal and Grievance Coordinator II, works as a member of the A&G team. Processing appeal and grievance requests in accordance with standards established for accuracy, timeliness, productivity, client performance commitments, and regulatory requirements (e.g. State Regulations, Federal Regulations, Professional Accreditations). Utilize various business applications (e.g. MedAccess, MedResponse Appeals, FileNet, RightFax, SalesForce) to perform analysis, obtain information, and enter data as required for assigned duties. Utilize reasoning skills to evaluate appeal and grievance requests for appropriateness and ensure processes are followed accordingly. General knowledge of Microsoft Excel in order to assist in managing and generating reports for appeals and grievances metrics. Ability to multi- task and cross-train to process both appeals and grievances to assist with the weekend rotation schedule. Assist the Lead Appeals and Grievances Coordinator III in performing new employee training. Interact with internal and external customers as required. Work under general supervision, relying on work instructions, policies & procedures, and available company resources to perform the functions of the position efficiently and effectively.Essential Functions and Responsibilities the following. Responsibilities include the following at a higher proficiency level than Appeals and Grievances Coordinator I.Evaluate and process Appeals and Grievances per establish work instructions and approved departmental documents.Perform and document outreach tasks (outbound calls or faxes) to obtain information necessary for processing Appeals and Grievances.Ensure Appeals and Grievances are finalized within the required turnaround time (TAT) in accordance with applicable laws and company policies.Provide and document required member and/or provider verbal notifications and review final written notifications for appropriateness.Provide excellent customer service and exhibit interpersonal communication skills (listening/verbal/written) when communicating with members and/or providers, collaborating with internal departments to address issues and inquires and when interacting with co-workers.Protect and maintain confidentiality and privacy of all member's personal and health information in accordance with federal requirements and company policies.Must comply with company and department policies, procedures, rules and regulations.Must possess the ability to adapt to departmental changes as required for the needs of the business. Must be flexible with shift changes.Additional Functions and Responsibilities include the following as Appeals and Grievances Coordinator II.Assisting management with the quality review program.Must be able to cross-train across the appeal and grievance task divisions.Managing and generating reports for appeals and grievances metrics.Assisting Appeals and Grievances Coordinator III with staff process training.Participating in the rotating weekend on-call schedule as needed.Supervisory ResponsibilitiesThis job has no supervisory responsibilities.QualificationsTo perform this job successfully, an individual must be able to perform each essential duty as expected by management. The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Education and/or ExperienceHigh school diploma or general education diploma (GED); 3 years related experience; or equivalent combination of education and experience.Previous Pharmacy Benefit Management experience preferred. Excellent proofreading abilities and data entry skills. Able to work independently with minimal supervision and/or in teams.Computer SkillsTo perform this job successfully, an individual should have knowledge of MS Office Suite.Proficiency of knowledge of Microsoft Word and Microsoft Excel.Certificates, Licenses, RegistrationsCertified Pharmacy Technician and/or state licensure as a Pharmacy Technician required. Certified Pharmacy Technician Certification preferred.Reasoning AbilityAbility to understanding, follow and apply detailed written and oral instructions. Ability to address problems involving a few variables in a standard process or requirement.Mathematical SkillsAbility to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals (basic math skills). Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.Language SkillsAbility to read and comprehend basic instructions and compose routine correspondence. Ability to effectively present information one-on-one or in a group setting to customers, clients, and other employees of the organization.CompetenciesTo perform the job successfully, an individual should demonstrate the following competencies:Oral CommunicationSpeak clearly and persuasively in positive or negative situations. Listen and obtain clarification when needed. Responds well to questions.Written CommunicationWrite clearly and informatively. Edit work for spelling and grammar.TeamworkBalance team and individual responsibilities. Exhibit objectivity and openness to others' view. Give and welcome feedback. Contribute to building a positive team spirit. Put the success of the team above own interests. Able to build morale and group commitments to goals and objectives. Support everyone's efforts to succeed.Organizational SupportFollow policies and procedures. Complete required tasks correctly and on time. Support organization's goals and values. Benefit organization through outside activities. Support affirmative action and respects diversity.Physical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be provided to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms. There are no specific vision abilities required by this job.Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations maybe provided to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.Working HoursThis is a non-exempt position requiring one to be able to work overtime from time to time to complete assigned task. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may change at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday between the hours of 6:00 am to 6:00 pm (Pacific Standard Time). Saturday and Sunday and some holidays between 6:00 am and to 2:30pm (Pacific Standard Time).TravelThis position requires no travel; however, attendance may be required at various local conferences and meetings.The Perks:Medical / Dental / Vision / Wellness ProgramsPaid Time Off / Company Paid HolidaysIncentive Compensation401K with Company matchLife and Disability InsuranceTuition ReimbursementEmployee Referral BonusTo explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careersMedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA:To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Disclaimer:The abovestatements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.