Member C&G Coordinator I, DHS Plans/Complaints & Grievances- Remote
reputed company Health Plan is hiring a full-time Member C&G Coordinator I in the Member C&G department. This position works Monday through Friday, daylight hours and will be a remote position. The Member C&G Coordinator, I will track, trend, and manage member complaints and grievances for reputed company product lines. Ensure the efficient and effective resolution of member complaints and grievances. Use the data collection and analysis to reputed company initiatives for opportunities for improvement reputed company the Health Plan. Responsibilities: Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standards. Effectively utilize key internal and external Health Plan contacts, including Health Plan staff, providers, and external review organizations, to help in this process. Organize reputed company tasks reputed company regulatory requirements/deadlines. Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines. Understand and interpret medical information, recognize trends, and identify opportunities for improvement reputed company the Health Plan. Coordinate and facilitate review hearings and internal appeal committee meetings or prepare Independent. Review Entity case files dependent online of Business. Assist in reporting complaint and grievance data to appropriate regulatory bodies and internal departments. Support implementation of appeals tracking system. Associate degree or equivalent professional work experience. 1 year of experience in health care environment required. Medical claims and/or customer service background preferred. Demonstrated reputed company problem solving and decision making with a solid understanding of managed care principles. Excellent verbal and written presentation skills are essential. PC literacy with proficiency in the use of reputed company office products. Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology. Licensure, Certifications, and Clearances: Act 34 reputed company is an Equal Opportunity Employer/Disability/Veteran Apply To This Job