HealthCare Support is currently seeking an experienced Grievance and Appeals Program Assistant to fill an opening with a a great health plan company in Orange, CA. The ideal candidate will have the following requirements for the Grievance and Appeals Program Assistant role * High School diploma or GED * 1 year of grievance and appeals experience * Familiar with Medi-Cal and Medicare * Ability to: * Provide professional support to supervisors and staff in program to which assigned. * Coordinate multiple administrative activities. * Work on specialized process or function to which assigned. * Establish and maintain effective working relationships with CalOptima Health's leadership and staff. * Ability to communicate clearly and concisely - verbal and written communication skills * Microsoft Office experience: Excel, Outlook, Word, PowerPoint * Strong tenure in past positions, 1-2 years in prior role Benefits for the Grievance and Appeals Program Assistant * Competitive salary: $20.81 - $24.42 - $28.02 ($43,281 - $50,790 - $58,300) * Benefits offered, Medical, Dental, and Life Insurance * Fun and positive work environment Assignment details for the Grievance and Appeals Program Assistant * Job Summary * Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent will work independently, exercising discretion and judgment and may assist in coordinating a function for the program assigned. The incumbent's primary responsibilities will include monitoring the GARS member and provider mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe. * Position Responsibilities * 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. * Serves as point of contact within or outside CalOptima Health for inquiries related to grievances and appeals. * Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers. * Monitors for inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), the Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS). * Responds to DMHC requests for information on a timely manner. * Works with internal and external departments and providers in gathering supporting information relevant to the case. * Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns to appropriate staff. * Generates acknowledgement letters for all lines of business per department and regulatory standards. * Assists in the development of departmental forms and intake process. * Coordinates administrative support for state hearings including serving as contact with DSS for incoming cases, entering cases in the GARS system, creating electronic file and routing the scanned documents to designated staff and faxing required state hearing documentation to local hearing office as necessary. * Completes other projects and duties as assigned. * Schedule: M-F, any 8 hour shift between 7am-8pm ?????Interested in being considered for the Grievance and Appeals Program Assistant Opportunity? If you are interested in applying to this position, please click Apply Now for immediate consideration or if you'd like to stand out email swfryel@healthcaresupport.com Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law. Company Description HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting C

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.