What are the responsibilities and job description for the Grievance & Appeals Coordinator with Bilingual Experience Must position at Synkriom?
JOB DESCRIPTION:
Position Title: Grievance & Appeals Coordinator
Client: IEHP
Job Summary:
The Grievance & Appeals Coordinator is responsible for coordinating, tracking, and processing member and provider grievance and appeal cases while ensuring compliance with CMS, DHCS, DMHC, and IEHP regulatory requirements. This role provides administrative support, maintains accurate case documentation, prepares correspondence, monitors case timelines, and collaborates with internal departments to ensure timely resolution of grievances and appeals.
Key Responsibilities:
Process, track, and document member and provider grievance and appeal cases.
Ensure compliance with regulatory guidelines and internal procedures.
Generate and distribute grievance and appeal correspondence within required timelines.
Coordinate with internal departments to obtain information and resolve cases.
Maintain case records, reports, and status updates for management.
Support investigations and case intake activities as assigned.
Communicate with members and providers regarding case-related inquiries.
Assist with process improvement initiatives and departmental goals.
Qualifications:
High School Diploma or GED required.
3 years of administrative experience in an office environment.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Strong data entry, organizational, and multitasking skills.
Excellent written and verbal communication skills.
Strong attention to detail and ability to meet deadlines.
Customer service experience and telephone etiquette required.
Bilingual English/Spanish (written and verbal) required for bilingual positions.
Healthcare, managed care, grievances, appeals, or regulatory compliance experience preferred.
Salary : $20 - $24