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Providence Health & Services Appeals and Grievance Coordinator in Mission Hills, California

Description:

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Providence is calling an Appeals and Grievance Coordinator Quality Management (Full-Time/Day Shift) to Providence Facey Medical Foundation in Mission Hills, CA. THIS POSITION IS TEMPORARY.

We are seeking an Appeals and Grievance Coordinator Quality Management who will provide assistance of a highly confidential nature for the Quality Management Department, Patient Liaisons and reports to Manager of Quality Management. Performs a variety of clerical duties such as typing of correspondence and various reports, filing, copying, scanning, faxing, and other duties as indicated. Acts as a health plan appeals and grievance coordinator and patient liaison responsible for assisting patients with questions and concerns regarding clinical services. Assists Quality Management Specialist, Manager of Quality Management, and Medical Directors with Health Plan Appeals and Grievances and Quality of Care issues involving a variety of duties such as requesting of medical records, scheduling, typing various correspondence to the health plans, and processing complaints through the Web-based complaint process. Will work with staff and patient liaisons to resolve concerns and improve services, tracks and analyzes all concerns and complaints, identifies trends and makes recommendations.

In this position you will:

  • Provide support for the Manager of Quality Management, Quality Management Department, Quality Management Medical Director, Quality Management Specialist and Patient Liaisons:

  • Deliver upon the service expectations of both our patients and fellow staff members by listening to their needs; engaging in positive interactions; and following through on promises made in a thoughtful, efficient, timely and courteous manner so that their total outcome is better than expected.

  • Respect the dignity, confidentiality and privacy of patients. Knowledge of HIPAA regulations and rules.

  • Work in a safe manner, adhering to general safety precautions and standards. Reports any unsafe conditions to their supervisor and/or the safety hotline.

  • Responsible for support to the Quality Management Department assisting wherever needed.

  • Act as customer service liaison to patients and staff of Facey Medical, maintaining superior customer service.

  • Provide assistance to management and staff in daily operations:

  • Maintain confidentiality of all related records and information, which pertains to all patients and employees.

  • Assist the Manager of Quality Management and the Quality Management Specialist R.N. in tracking and analyzing all concerns and complaints. Assists in identifying trends and makes recommendations. Reports on problem areas and suggests improvements.

  • Display courtesy and consideration to all patients, physicians and staff to enhance a positive image.

  • Answer the telephone within three rings, records accurate messages and/or directs incoming calls to the appropriate resources/department/extension.

  • Gather and researches appropriate information in a confidential manner adhering to all HIPAA regulations and policies.

  • Understand medical terminology.

  • Distribute incoming mail/fax transmittals and identifies correspondence requiring immediate action.

  • May assist with Quality Assurance projects when appropriate and requested through Quality Management Department.

  • Maintain and updates Quality Management Policies and Procedures Manual.

  • Assist in the distribution of reports and flyers. Types and assists with composing correspondence, reports, records and other documents. Ability to use the computer for analysis, graphs and report writing.

  • Ability to effectively communicate both verbally and in writing and to establish and maintain effective relationships with wide variety of people.

  • Attend all staff, patient liaison meetings and other specified meetings as assigned.

  • Record and transcribes meeting minutes as assigned.

  • Responsible for departmental scanning, filing, maintaining grievance and appeals files and expedited appeals and grievance logs.

  • Responsible for reviewing of Event Reports and referring them to the Quality or Risk Management Medical Director for review. Also responsible for scanning and filing Event Reports.

Qualifications:

Required qualifications for this position include:

  • 1 year clerical office experience, or equivalent.

  • Ability to communicate/interface effectively both verbally and written at all levels with internal and external customers.

  • Excellent customer service skills.

  • Must have initiative and use proper judgment with general supervision.

  • Must be detail-oriented, organized, able to prioritize and manage multiple projects.

  • Must be computer literate in Word Processing, Power Point, and Excel, ability to type 45-50 wpm and use Microsoft applications.

Preferred qualifications for this position include:

  • Healthcare background.

  • Knowledge of IDX scheduling

About the hospital you will serve.

Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.

Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Quality/Risk/Safety (Non-Clinical)

Location: California-Mission Hills

Req ID: 302849

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