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Appeals Grievances Coordinator

Company: Bright Health
Location: California City
Posted on: September 18, 2022

Job Description:

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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives - apply to join our team.

General Purpose:

Provide administrative support to the A&G Department including filing, scanning, conduct follow-up calls, setting up initial cases in the Appeals & Grievance module, etc.

Duties and Responsibilities:

  • Be at work/cubicle timely based on the work schedule on file and ready to handle assignments professionally; must follow company and department guidelines for all time off/vacation/overtime requests.
  • Processes, researches and responds to members and authorized representatives' inquiries regarding appeals and grievances received by
  • phone, fax or mail in accordance with policies and procedures and regulatory guidelines
  • Responsible for investigating and resolving all priority issues and/or concerns in a timely and efficient manner.
  • Answers telephone inquiries and maintains a professional level of telephone etiquette.
  • Responds to any questions from members and authorized representatives regarding appeals and grievances.
  • Must be able to accomplish duties and assignments with minimal supervision.
  • Input newly received appeals and grievances in the Appeals & Grievance module
  • Make follow-up calls to provider offices to request case information as needed
  • Scan cases into Appeals & Grievance module and associated network drive
  • Create and maintain member file
  • Handle department faxing
  • Check and distribute documents to A&G coordinators
  • Maintain file systems
  • File member files/cases based on instruction given
  • Maintain files and records so they remain updated and easily accessible
  • Sort incoming mail and prepare outgoing mail (envelope, postage, etc.)
  • Monitor stocks of office supplies and report when there are shortages
    • High school GED required
    • Previous experience in healthcare, customer service or A&G preferred
    • Bilingual in Chinese, Vietnamese, Korean or Spanish required (speaking and reading; writing preferred)
    • Proficient knowledge of Microsoft Office
    • Very good communication, organizational and multi-tasking abilities
    • Ability to follow directions and perform work independently according to department and senior management standards
    • Able to function effectively under time constraints
    • Willingness to accept responsibility and desire to learn new tasks

      We're Making Healthcare Right. Together.

      We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:

      Focusing on Consumers We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.

      Building on Alignment We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.

      Powered by Technology

      We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.

      As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Keywords: Bright Health, Lancaster , Appeals Grievances Coordinator, Other , California City, California

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