Pompano Beach, FL
Grievance Coordinator | Remote
About Albion Staffing Solutions:
Albion has been offering Temp; Contract and Direct Hire Staffing Services for 20-years from offices located throughout South Florida. Offering General Admin/Clerical and Light Industrial staffing services, Albion also specializes in the Logistics, Allied Healthcare and Banking industries.
Albion Staffing Solutions is looking for Grievance Coordinator. Under minimal supervision, the Grievance Coordinator is responsible for timely intake, processing, researching, documenting and responding to grievances referred by our clients health plan partners. The Coordinator is responsible for entering pertinent information into the designated portal/database, communicating with contracted providers to resolve cases, communicating with contracted health plan partners, tracking case load aging, escalating issues prior to expiration of standard processing timelines, and maintaining compliance with all processing timelines established within the Compliance & Quality Department.
- Responsible for the handling of assigned grievances referred by contracted health plan partners, writing acknowledgements, obtaining pertinent records as needed, researching cases, resolving issues and ensuring time-frames are met for acknowledgement and resolution. Must comply with all regulatory requirements and company policies.
- Responsible for investigating and resolving all priority issues and/or concerns reported by the health plan through the grievance portal in a timely and efficient manner. These issues require immediate attention due to the nature of the concern.
- Works closely with internal departments to resolve and research health plan member grievances and to obtain additional information to provide to the health plan to adequately resolve and respond to the grievance.
- Maintains complete and accessible grievance cases via the designated portal system.
- Contacts providers and health plan partners to obtain additional information to adequately resolve and respond to assigned grievances.
- Provides timely resolution of customer complaints, concerns, and inquiries.
- Responds professionally to all customer requests related to grievances.
- May work with internal clinical staff who oversee clinical aspects of the business, to ensure that the clinical issues are appropriately evaluated.
- Demonstrates an understanding of the functions of other departments and affiliates while communicating appropriately to maintain positive working relationships. Supports department in administrative, data management and clerical duties.
- Responsible for addressing and forwarding quality of care complaints to quality management for resolution and/or assisting in investigation in conjunction with the Quality Management Medical Review.
- Responsible for addressing and forwarding fraud and abuse allegations to the Compliance Department for resolution and/or assisting in the investigation in conjunction with the grievance.
- Responsible for formulating/implementing and executing all processes, requests, workflows or policies as requested by management in a courteous and efficient manner, including offering a proactive approach to suggestions and recommendations and working or cooperating with all office associates and management.
- Participates in staff meetings.
- Minimum High School Diploma or GED required.
- One to two years previous experience in appeals and grievance, utilization management, or member services preferred.
- Ability to successfully interact with providers, health plan personnel and health plan members
- Excellent time management skills.
- Excellent organizational skills and ability to handle multiple tasks.
- Excellent verbal and written communication skills.
- Excellent proficiency in Excel, Word and Access.
- Attention to detail and accuracy and capability of meeting deadlines consistently.
- Ability to understand and follow written and verbal instructions.
- Professional appearance and demeanor.
- Bilingual skills a plus.
Applicants will work remotely
- Strict Covid-19 Protocols applicable.
- Albion uses E-Verify to verify employment eligibility.
- Pre-Employment and random Drug and Background testing applicable.
- Only Local Candidates will be considered; no relocation provided.
- Reliable Transportation to/from the workplace is necessary.