<h3>Job Description</h3>
Job Description
Grievance and Appeals Coordinator CalOptima $28-31/HR Orange CA - 92868 Duties &amp; Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Maintains adequate information in CalOptima Health’s systems; ensures data collection, summarization, integration and reporting which includes case creation and management and events/activity tracking. Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal or supplemental information required to evaluate grievances and appeals within regulatory requirements. Coordinates and participates in case discussions with operational experts to result in a final case disposition as needed. Evaluates case details, proposes recommendations or makes decisions as applicable and ensures the organization’s decision is implemented according to the Grievance and Appeals policies and case resolution. Develops resolution letters and correspondence to members and providers. Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals. Contacts appropriate parties to request and obtain missing information and supporting documentation or provides education. Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions. Responds to routine provider inquiries via phone, assisting with provider appeals resolution inquiries. Assists with the health networks’ compliance process. Identifies trends and root causes of issues, proposes solutions or escalates ongoing issues to management. Meets performance measurement goals for Grievance and Appeals Resolution Services. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High school diploma or equivalent PLUS 1 year of experience with Provider Dispute Resolution (PDR) in Medicare and Medi-Cal in professional, institutional, outpatient, ancillary, coordination of benefits and government cases required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of experience with Medicare or Medi-Cal provider appeals and denials process required. 1 year of experience in any of the following areas: Grievances and Appeals, Claims Administration, Regulatory Compliance, Customer Service or related field required. Preferred Qualifications: Associate degree in business, health care administration or related field. Experience in health care practice standards, for both government and commercial plans. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: N/A Knowledge &amp; Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. &nbsp;
Company DescriptionIT Mantra, LLC. is a Certified Woman / Minority (WBE/MBE) owned company founded in 2003 and based in Massachusetts. We provide a comprehensive range of IT and Professional Staffing and Workforce Solutions that include contract, contract to hire and direct hire placement services as well Employer of Record (EOR) services nationally and specialize in the placement of women and diverse personnel. 
<h3>Company Description</h3>
IT Mantra, LLC. is a Certified Woman / Minority (WBE/MBE) owned company founded in 2003 and based in Massachusetts. We provide a comprehensive range of IT and Professional Staffing and Workforce Solutions that include contract, contract to hire and direct hire placement services as well Employer of Record (EOR) services nationally and specialize in the placement of women and diverse personnel.

Grievance and Appeals Coordinator

<h3>Job Description</h3>
Job DescriptionDescription:
 
Purpose:
The Student Services Advisor is responsible for the overall support of the Student Services Department providing day-to-day support and direction with respect to policies, practices, systems and community support. The Student Services Advisor supports the Student Services department with respect to scheduling and work assignments, Title IX compliance, ADA coordination, student complaints, grievances, appeals and performing other duties as required. The Student Services Advisor contributes to the College’s success by providing input into the development of the campus’ strategic and operational plans, and by ensuring that the campus achieves its student engagement, retention, and completion goals in a student centric campus environment. Responsible for taking a leadership role in cultivating and creating Smith Chason College campus spirit and pride.
 
Qualifications:
<ul>
<li>Bachelor’s degree preferred. Acceptable experience includes at minimum, 2-3 years of administrative experience. Recommended competencies include:</li>
<li>Must have strong technical skills including all computer applications, internet research, database management, and analytical skills.</li>
<li>Ability to prioritize, multi-task, perform well under pressure, meet deadlines, and work flexible schedule. </li>
<li>Ability to communicate with high level industry supervisors and management teams. </li>
<li>Strong ability to work independently as well as collaboratively with other team members. </li>
<li>Ability to engage in critical thought and analyze all types of quantitative and qualitative data into reports and presentation for strategic planning and problem-solving.</li>
<li>Ability to provide support and ensure accountability for results.</li>
<li>Strong organizational skills.</li>
<li>Effective time management skills; ability to separate important issues and identify priorities.</li>
<li>Ability to track, monitor, assess and evaluate student progress and registry outcomes.</li>
<li>Possesses strong motivational skills, oral and written communication proficiency.</li>
<li>Provide excellent customer service to all members of the WCUI community.</li>
<li>Must have strong documentation skills.</li>
<li>Demonstrates integrity, credibility, confidentiality, and responsibility in all interactions.</li>
<li>Possesses high ethical standards and an honest, open, and consistent approach to working with peers, employees, employers and staff.</li>
<li>Individuals must be professional in all aspects of the position including appearance, demeanor, communication and attitude.</li>
</ul>
Reports to:
Senior Student Services Manager
 
Responsibilities:
<ul>
<li>Represent and support the Department of Student Services, ensure safety of students, regulatory compliance, consistency of practice and excellent student/customer service </li>
<li>Manage the Department’s work with faculty and staff, colleagues, students and community partners to support, provide and/or facilitate activities that ensure that the campus achieves its student engagement, satisfaction, retention, and completion goals </li>
<li>Provide analysis and advisement in relation to policies, procedures, and operational plans regarding students and services for students, including risk management. </li>
<li>Monitor, manage and enforce Satisfactory Academic Progress and Attendance Policies </li>
<li>Provide support with Title IX compliance</li>
<li>Work with the ADA Compliance Coordinator to facilitate all communication for requests for accommodations, ensure approved accommodations are communicated and managed and support students with the grievance process </li>
<li>Address complaints and conducts investigations as directed by the Senior Student Services Manager</li>
<li>Ensure that Student Services Department monitors students’ attendance and academic performance on a weekly basis, progress toward program completion, providing or recommending interventions as needed </li>
<li>Ensure the Student Services Department maintains appropriate documentation with regards to advising sessions including meeting overviews, progress notes, referrals, and follow-up activities. </li>
<li>Ensure that the Student Services Department follows all regulatory bodies </li>
<li>Lead in the developing and conducting of student events including but not limited to orientation, community outreach, graduation and student appreciation </li>
<li>Maintain knowledge of Smith Chason College programs, campus resources, information systems, and policies and procedures </li>
<li>Additional job-related duties as required and assigned</li>
</ul>
 
PHYSICAL REQUIREMENTS/ WORKING CONDITIONS
The 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 made to enable individuals with disabilities to perform the essential functions
<ul>
<li>Must be able to remain in a stationary position for prolonged periods of time</li>
<li>Can independently move objects up to 25 lbs.</li>
<li>Sufficient hand, arm, and finger dexterity to operate a computer keyboard, other office machinery, and perform repetitive motions</li>
<li>Must have sufficient hearing and speaking ability to communicate in person or on the phone/computer with others</li>
<li>Must be able to occasionally function in activities that include walking, bending, squatting, and reaching</li>
</ul>
 
CULTURE OF CARE
Culture of Care is our commitment to create a supportive environment in which every student can achieve their educational and career goals. Culture of Care encourages one-on-one relationships. Creating a culture that focuses on the student and their wellness. This includes understanding the student's complex lives. It is about creating a school where everyone feels welcomed by: 
· Creating a sense of community in all interactions and communications with students 
· Identifying problem areas and offering assistance 
· Opening up safe conversations for cooperative solutions 
· Holding students to standards and goals that will ultimately make them successful in their careers
 
Requirements:

Student Services Advisor

<h3>Job Description</h3>
Job Description
 
Position Summary:
Performs a wide variety of duties to support the Customer Experience Department including data entry, new member welcome calls, clerical work and filling. Handling of all incoming mail and compiles and completes return mail reports as required. Serves as back up to the call center as required. 
 
Essential Duties and Responsibilities:
<ol>
<li>Processes all returned mail for the Customer Experience department.</li>
<li>Keeps running log of all returned mail and attempts outreach to members to obtain updated demographic information.</li>
<li>Conducts new member welcome calls for all new MMA enrollees.</li>
<li>Provides clerical support for the department leaders.</li>
<li>Provides back up to call center when needed.</li>
<li>Provides the Grievance and Appeals Coordinator with clerical support when needed.</li>
<li>Performs mails outs for multiple lines of business as needed.</li>
<li>Prints member ID cards as requested.</li>
<li>Exercises initiative, judgement, discretion, and decision-making abilities in order to achieve organizational objectives.</li>
<li>Establishes and maintains effective working relationships with administrative staff, co-workers, and members.</li>
<li>Communicates with other departments and management to resolve problems and expedite work.</li>
<li>Performs other related duties as assigned.</li>
</ol>
This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
 
Qualifications: 
<ul>
<li>High School diploma or General Education diploma (GED)</li>
<li>1-2 years of experience.</li>
<li>Knowledge of word processing software, spreadsheet software, internet software.</li>
</ul>
Skills and Abilities:
<ul>
<li>Ability to effectively present information and respond to questions from groups of managers, clients, members, and the general public.</li>
<li>Ability to define problems, collect data, establish facts, and draw valid conclusions.  </li>
<li>Time management skills.</li>
<li>Ability to work in stressful environments.</li>
<li>Ability to work independently with a focus on decision making.</li>
</ul>
Work Schedule:
 Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.
 
Physical Demands: 
The 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 made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.
 
Work Environment: 
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.

Member Services Data Coordinator

<h3>Job Description</h3>
Job Description
As an Appeals and Grievances Coordinator you'll play a crucial role in efficiently processing appeal and grievance requests, ensuring smooth operations, and maintaining excellent communication.
Responsibilities:
<ul>
<li>Support the team in processing appeal and grievance requests promptly and efficiently.</li>
<li>Communicate effectively with the team about special projects and priorities.</li>
<li>Monitor and distribute incoming faxes and emails to the appropriate departments.</li>
<li>Review and prioritize written appeals and grievances.</li>
<li>Enter and document new appeals or grievances received via various channels.</li>
<li>Assist in obtaining additional information and follow-up as needed.</li>
<li>Maintain accurate documentation of all communications and actions.</li>
<li>Coordinate meetings, including scheduling, invites, agendas, and minutes.</li>
<li>Provide administrative support to the Appeals and Grievances Supervisor and Utilization Operations Director.</li>
</ul>
Qualifications:
<ul>
<li>High School Diploma.</li>
<li>6 months of experience in an administrative role.</li>
<li>1 year of experience in a customer service role.</li>
<li>Previous experience in the healthcare industry and with Facets and Salesforce is a plus.</li>
<li>Intermediate computer skills, including email, database activity, word processing, and spreadsheets.</li>
</ul>
Sacramento, CA 95833 Monday to Friday 8am - 5pm
potential to go hybrid
3+ contract covering for a leave
 Pay Details: $20.00 to $23.00 per hour Search managed by: Joanna Calderon Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable. Equal Opportunity Employer/Veterans/Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to <a href="https://www.lhh.com/us/en/candidate-privacy" target="_blank">https://www.lhh.com/us/en/candidate-privacy</a> The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: 
<ul>
<li>The California Fair Chance Act</li>
<li>Los Angeles City Fair Chance Ordinance</li>
<li>Los Angeles County Fair Chance Ordinance for Employers</li>
<li>San Francisco Fair Chance Ordinance</li>
</ul>

Appeals and Grievance Specialist

<h3>Job Description</h3>
Job Description
Capital University is committed to fostering a campus environment free from sexual harassment and discrimination and does not discriminate against students, faculty or staff based on sex in any of its programs or activities, including but not limited to educational programs, employment, and admission. Working with campus partners, the Title IX Coordinator will lead the university's efforts to foster a living, working and education environment that is free from harassment, discrimination, and sexual misconduct through prevention and education efforts as well as ensuring a fair, impartial process for all individuals involved in a Title IX investigative process. The Title IX Coordinator has primary responsibility for coordinating and implementing Capital University's Title IX compliance efforts, across its two campuses in Bexley and Columbus, Ohio, respectively. The Title IX Coordinator will work closely with campus partners to facilitate a fair and equitable conduct process for all who are involved in the process.
 
As Title IX Coordinator, this individual is responsible for managing the day-to-day responsibilities associated with the University's obligations under Title IX of the Education Amendments of the 1972 Civil Rights Act and the Clery Act, as amended by the Violence Against Women Act.
 
Primary roles and responsibilities: 
<ul>
<li>Complaint Process Management: Coordinate the prompt, effective, and equitable intake, investigation, and timely resolution of all allegations of sex or gender-based discrimination, harassment, and retaliation, pursuant to applicable state law, federal law, and university policy; Ensure that investigation findings and outcomes are consistent with applicable regulations and are properly documented; Collaborate with outside professional partners to assign investigators, decision-makers, and hearing advisors for Formal Complaints; Conduct Informal Resolution processes and Formal Hearings; Coordinate supportive measures for Complainants and Respondents in Title IX processes; Oversees sanction completion and maintains Informal Resolution and Supportive Measure accommodations. Selects, trains, and designates Deputy Title IX Coordinator(s) and Investigative team across critical areas of the institution to ensure all involved with processing Title IX complaints are adequately trained in compliance with Title IX guidance.</li>
</ul>
 
<ul>
<li>Policy Compliance: Ensures ongoing compliance with Title IX by collecting and analyzing data, writing comprehensive reports and maintaining records of investigations.; Act as the point of contact for campus community, governmental agencies, and members of the public regarding information or concerns regarding sex or gender-based discrimination, including sexual misconduct. Serves as point of contact for Ohio Department of Higher Education and Changing Campus Culture initiative; Implements and regularly reviews policies and procedures that meet all relevant legal requirements; Provide Clery reportable incidents to the Clery Report and Annual Safety Report; Maintain a comprehensive case management system that organizes, manages, and tracks all reports and preserves other Title IX documentation as required by law; Fulfill governmental reporting responsibilities; Oversee protocols for campus responses to data requests from internal and external constituents and agencies; Remain current regarding state and federal law, including but not limited to Title VII, Title IX, VAWA, Campus Save Act, Clery Act, and FERPA; Develop, implement, and review policies, procedures, and grievance procedures as they relate to Title IX, sex or gender-based discrimination, sex harassment, and sexual and relationship violence. Remain current regarding trends in the field of education related to sex or gender-based discrimination and sexual misconduct.</li>
</ul>
 
<ul>
<li>Prevention and Education: Develop and implement long-term goals for programming, services, education, and assessment of Title IX compliance efforts; Select, train, and oversee designated Title IX Investigators across critical areas of the institution; ensure investigator, adjudicator, and those involved with processing Title IX complaints are adequately trained in compliance with Title IX guidance; Provide Title IX compliant training to investigators, decision makers, and facilitators of informal resolutions and ensure that all new hires, employees and students receive annual Title IX training; Provide students, faculty, and staff with information regarding the university complaint process, available resources, supportive measures, and reporting and resolution options; Leads the development and/or implementation of University climate surveys pertaining to sexual misconduct, sexual harassment, domestic violence, dating violence, and/or stalking; Monitors and maintains the College's Title IX webpage and materials; Meet regularly with key constituencies regarding shared concerns (e.g. Fraternity and Sorority Life organization leadership councils, athletics, Residential and Commuter Life, etc.); Maintains and updates informational and outreach materials regarding Title IX and sexual relationship violence, including a webpage. Participate in the Wellness and Prevention Team to coordinate programming.</li>
</ul>
 
<ul>
<li>Support in other University processes: Serve as a hearing, appeals or investigative officer in other university processes including but not Anti-Hazing, Bias Response, Student Conduct, and Accessibility Services.</li>
</ul>
 
Qualifications: 
<ul>
<li>Master's degree with at least two years of relevant experience required. J.D., PhD, or EdD Preferred. </li>
<li>Ability to understand, communicate with and effectively interact with people across cultures. Possesses a positive attitude towards cultural differences. Willing to gain knowledge of different cultural practices and world views and determine how those practices and views will factor in during investigations, complaints, reports, findings, etc.</li>
<li>To perform this job successfully, an individual should have prior experience in: Maxient, Microsoft Word, Excel, Access, PowerPoint, Outlook, and Social Media Sites (Facebook/Twitter).</li>
<li>Ability to respond to common inquiries or complaints from students, employees, customers, regulatory agencies, or members of the business community. Ability to write investigation reports, speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.</li>
<li>This position requires the ability and/or skill to collaborate and work closely and professionally with others as part of a team regardless of race, gender, sexual orientation, etc.; be flexible; have attention to detail; work without supervision, a demonstrate initiative; communicate professionally through both verbal and written means; manage multiple priorities under tight deadlines; establish departmental goals and priorities; and contribute to Capital University's philosophy, diversity and inclusion initiatives, strategic plan, goals, and doctrine.</li>
<li>Ability to facilitate discussion groups and workshops; ability to coordinate events; ability to update and maintain social media presence and organizational listservs.</li>
</ul>
 
Applicants must submit resume and cover letters.
 
For more information on Capital University, visit our website at <a href="http://www.capital.edu" target="_blank">www.capital.edu</a>.
 
Capital University offers a rich benefits package that includes medical, dental, vision, retirement, family education benefits, short-term and long-term disability, life insurance and free parking. 
 
Capital University is an equal opportunity employer. Capital University does not discriminate on the basis of race, color, national or ethnic origin, sexual orientation, religion, sex, gender, age, disability, veteran status, or other characteristics protected by the law.
 Job Posted by ApplicantPro

Title IX Coordinator

<h3>Job Description</h3>
Job DescriptionOverview: TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc. Title: Grievance &amp;Appeals CoordinatorWork Location: Detroit, MI, 48226Duration: 6 Months Job Type: ContractWork Type: RemoteDept: 126160Engagement Description:
<ul>
<li>Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. </li>
<li>Contact customers to gather information and communicate disposition of case. </li>
<li>Conduct pertinent research in order to evaluate, respond to, and finalize case. </li>
<li>Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions. </li>
<li>High School Diploma or GED required. </li>
<li>Bachelor's Degree in English, Communications or related field preferred. </li>
<li>Two (2) years customer service experience required. </li>
<li>Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. </li>
<li>Strong project management skills preferred. </li>
</ul>
Top 3 Required Skills/Experience 
<ul>
<li>Experience handling a large load of work in a fast-paced environment and have computer skills! </li>
<li>Insurance, Medicare/CMS knowledge </li>
<li>Customer Service Experience </li>
</ul>
Required Skills/Experience The rest of the required skills/experience. Include: 
<ul>
<li>Writing Letters </li>
<li>Analytical thinker </li>
<li>Research Skills </li>
<li>Multi-task </li>
</ul>
Preferred Skills/Experience Optional but preferred skills/experience. Include: 
<ul>
<li>Grievance and Appeals experience. </li>
<li>Degree in Healthcare/computer skills </li>
<li>Experience in analyzing a claim </li>
<li>Experience in classification between a grievance/appeal/organizational determination. </li>
<li>Letter writing </li>
<li>Basic computer skills. How to save a PDF, how to navigate excel, learning new systems </li>
</ul>
Education/Certifications Include: 
<ul>
<li>Healthcare, English</li>
</ul>
TekWissen Group is an equal opportunity employer supporting workforce diversity.

Grievance &Appeals Coordinator

<h3>Job Description</h3>
Job Description
Job Title: Grievance &amp;Appeals Coordinator
Location: Remote
Duration 6+ months
Dept: MA Grievances and Appeal Will this position be required to work onsite for any reason at any time? No, fully remote Engagement Description – Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions.
 Top 3 Required Skills/Experience – • Experience handling a large load of work in a fast-paced environment and have computer skills! • Insurance, Medicare/CMS knowledge • Customer Service Experience Required Skills/Experience – The rest of the required skills/experience. Include: • Writing Letters • Analytical thinker • Research Skills • Multi-task Preferred Skills/Experience – Optional but preferred skills/experience. Include: • Grievance and Appeals experience. • Degree in Healthcare/computer skills • Experience in analyzing a claim • Experience in classification between a grievance/appeal/organizational determination. • Letter writing • Basic computer skills. How to save a PDF, how to navigate excel, learning new systems Education/Certifications – Include: • Healthcare, English
High School Diploma or GED required. Bachelor's Degree in English, Communications or related field preferred. Two (2) years customer service experience required. Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. Strong project management skills preferred.
Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b 
<h3>Company Description</h3>
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.\r\n\r\nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.\r\n\r\nKyyba is an Equal Opportunity Employer.\r\n\r\nKyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

Grievance & Appeals Coordinator

<h3>Job Description</h3>
Job Description
Hi All,
My name is Poornachandra Rao and I'm a recruiter at Kyyba. We specialize in recruiting professionals at all levels (both contract and perm). I came across your profile and believe you are a great fit for one of the opportunities. I've included the job description here for your review. Please let me know if you’re interested and like to discuss this opportunity in greater detail. You can reach me at (248) 254 4299
Fully Remote- Mostly C2H after Contract based on the performance

Job Title : . Grievance &amp;Appeals Coordinator
No of Positions : 08
Duration : 6+Months (C2H)
Must have : Our G&amp;A Coordinators handle each case from start to finish, conducting all research, analysis, making the final determination, and drafting a response letter.&nbsp; Individuals must be able to formulate free form letters that take complex issues and explain them in a clear and simple manner.&nbsp;
Engagement Description – Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions. High School Diploma or GED required. Bachelor's Degree in English, Communications or related field preferred. Two (2) years customer service experience required. Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. Strong project management skills preferred. Top 3 Required Skills/Experience – • Experience handling a large load of work in a fast-paced environment and have computer skills! • Insurance, Medicare/CMS knowledge • Customer Service Experience Required Skills/Experience – The rest of the required skills/experience. Include: • Writing Letters • Analytical thinker • Research Skills • Multi-task Preferred Skills/Experience – Optional but preferred skills/experience. Include: • Grievance and Appeals experience. • Degree in Healthcare/computer skills • Experience in analysing a claim • Experience in classification between a grievance/appeal/organizational determination. • Letter writing • Basic computer skills. How to save a PDF, how to navigate excel, learning new systems Education/Certifications – Include: • Healthcare, English,
Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b 
<h3>Company Description</h3>
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.\r\n\r\nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.\r\n\r\nKyyba is an Equal Opportunity Employer.\r\n\r\nKyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

<h3>Job Description</h3>
Job DescriptionPosition Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.&nbsp; As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the Appeals Department leaders, the Appeals Coordinator level II team member will assist Appeals leadership with daily administrative work within the department. The Appeals Coordinator level II performs research, investigation, and analysis of appeals, grievances, and other types of complaints filed by providers and clients to administer timely resolution. &nbsp;Responsible for all aspects of nonclinical appeals and inquiries Responsibilities This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of the department and NYCHSRO/MedReview in general.
<ul>
<li>Prepare and disseminate case file for External Reviews and/or State Fair Hearing</li>
<li>Manage and monitor all appeals from Non-Participating providers</li>
<li>Independently prepare well written, customized responses to all provider inquiries/complaints that appropriately and completely address the complainant’s issues and are structurally accurate. </li>
<li>Ensure timely review, research, and resolution of appeals, grievances, and complaints within guidelines. Ensures that all complaints are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy</li>
<li>Consults with managers on problem cases and interfaces with clinical supervisors, account managers, and other personnel in resolving health plan requests or provider inquiries</li>
<li>Log and track grievances, appeals, and other types of complaints as needed. </li>
<li>Review and determine outcome of appeal/grievance, either independently or in conjunction with clinical appeal staff. </li>
<li>Consults with subject matter experts and resources available within organization to assist in appeal and complaint resolution.</li>
<li>Make critical decisions regarding research and investigation to appropriately resolve all inquiries</li>
<li>Serve as a liaison to Appeal Coordinator providing guidance and expertise to ensure timely resolution of cases</li>
<li>Other duties and responsibilities as assigned</li>
</ul>
 Qualifications: &nbsp;
<ul>
<li>Associates Degree. Additional years of related experience may be used in place of education requirements</li>
<li>3+ years’ experience working in the health care industry</li>
<li>Experience in inpatient claims, DRG and High-Cost Outlier claims preferred</li>
<li>Experience in DRG Pricing using WebStrat</li>
<li>Knowledge in claim payment methodology </li>
<li>Good MS Office skills. Particularly Excel </li>
<li>Excellent problem solving and analytical skills required</li>
<li>Ability to manage priorities in a complex environment.</li>
<li>Excellent organization and time management skills required</li>
<li>Excellent written and verbal communication skills</li>
<li>Takes initiative to proactively identify and solve problems</li>
<li>Ability to meet strict, time sensitive deadlines</li>
<li>Ability to cope well with ambiguity and stressful situations</li>
<li>Must show patience and the ability to remain calm under pressure in an atmosphere of frequent interruptions</li>
</ul>
 Remote Work Requirements
<ul>
<li>High speed internet (100 Mbps per person recommended) with secured WIFI. </li>
<li>A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.</li>
<li>Must be able to sit and use a computer keyboard for extended periods of time.</li>
</ul>
 Benefits and perks include: &nbsp;
<ul>
<li>Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.</li>
<li>401(k) with Employer Match - Join the team and we will invest in your future</li>
<li>Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.</li>
<li>Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.</li>
<li>Learning &amp; Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.</li>
</ul>
 Salary Range: $50,000- $55,000/ annually. &nbsp;
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11 grievance-and-appeals-coordinator Jobs