Member Grievance & Appeals Clerk - Roseville, CA

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

At Gainwell you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. .

Your role in our mission

• Retrieves new appeals information from the Appeals Case Management System (ACMS), researches denial, saves all pertinent documents and enters into the State Hearing System (SHS) and the Customer Relationship Management System (CRM) using ACMS, MEDS, CD-MMIS, and EIMS
• Mails Conditional Withdrawal letters, radiograph requests, EPSDT requests and Position Statements, reviewing all for HIPAA accuracy and uploads Position Statements, Conditional Withdrawals, and additional information to ACMS.
• Monitors CRM’s State Hearing and State Hearing email queues. Closes completed cases and forwards cases from email queue that require follow-up by analyst.
• Updates the SHS and/or CRM system with hearing schedules, pre-hearing contacts, additional information received, Open Record letters and decisions.
• Scanning and uploading incoming documents and creating tasks in ACMS for case completion
  
  

What We're Looking For

• Strong Communication (oral and written).
• Strong typing and word-processing skills are a must.
• Excellent organizational skills needed. Problem-solving, basic math, and computer skills needed.
• Ability to navigate through several work systems simultaneously desired. Microsoft Word, CD-MMIS, MEDS, and Excel experienced preferred.
• Medi-Cal Dental or dental office experience preferred.
  
  

What You Should Expect In This Role

• Must be a resident of the Greater Sacramento area of California
• This posting is intended for pipelining. We will accept applications on an ongoing basis.
  
  

The pay range for this position is $37,500.00 - $53,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.