Appeals and Grievances Coordinator

Job Description - Appeals and Grievances Coordinator (2400021X)DescriptionThe Appeals and Grievance Intake Coordinator plays a pivotal role in ensuring the highest standards of patient care, regulatory compliance, and overall satisfaction within our Medicaid health plan. This individual will be responsible for supporting the daily functions and operations of the appeals and grievances department under the direction of the Manager of Appeals and Grievances.QualificationsHigh school diploma or GED - requiredBachelor's or Master's Degree - preferredCustomer service experience in a health care office environmentRequired SkillsAbility to succinctly deliver pertinent information to a variety of audiences to include members, practitioners, organizational executives, attorneys and/or accreditation and regulatory auditorsWorking knowledge of computers and word processing programsExperience working with vulnerable populationsCustomer service experienceGrievances & Appeals process knowledgeExceptional interpersonal and problem-solving skillsPositive and approachable demeanorStrong written and oral communication skillsProficient in MS Office applications (Word, Excel, PowerPoint)Strong knowledge of Medicaid regulations and compliance requirementsDocument all grievances in an accurate and timely manner per policy, related follow-up activities and final outcomes in designated systems following the organization policyProvide timely assistance to members to file a grievance and ensure members are advised of appeal rights according to the organizational policy and applicable regulationsWork collaboratively, coordinating, communicating, and integrating recommendations from impacted organizational departments and/or Senior Level Executives and other designated staff, as approved and requiredReceive and process appeals and grievances following organizational policies and proceduresCollaborate to resolve member complaints efficiently and effectivelyPerform root cause analysis to identify areas for quality improvementCollaborate with cross-functional teams to implement process enhancementsMaintain accurate records of all appeals and grievances activitiesProvide recommendations and identify improvement opportunities to reduce risk of non-compliance with appeals and grievance requirementsCollaborate with applicable business owners to develop and update Appeals and Grievances policies and proceduresEnsure strict adherence to Medicaid regulations, policies, and proceduresStay up to date on regulatory changes and update processes accordinglyPrepare, generate and submit required reportsDevelop and deliver training programs on appeal and grievance processesPromote a culture of compliance and patient-centered care through educationInvestigate and resolve assigned member grievances within required timeframesPrepare, attend, and present grievance documentation as neededMaintain current knowledge of HSCSN’S Appeals and Grievance policies and proceduresMay perform other duties in addition to those outlined in this job descriptionDC RESIDENTS ENCOURAGED TO APPLYPrimary Location

District of Columbia-WashingtonWork Locations

HSCSN - Vermont Ave1101 Vermont Ave NWWashington 20005Job

Non-Clinical ProfessionalOrganization

HSC W/Special NeedsPosition Status: R (Regular) - FT - Full-TimeShift: DayWork Schedule: M-F 8:30-5PMJob Posting

Jul 24, 2024, 8:45:27 PMFull-Time Salary Range

48588.8 - 80974.4Health Services for Children with Special Needs (HSCSN) is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here:Know Your Rights Pay Transparency Nondiscrimination Poster.Please note that it is the policy of Health Services for Children with Special Needs (HSCSN) to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

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