Grievance and Appeal Intake Coordinator - Denver Health Medical Plan (Must Be A Resident of Colorado)

We are recruiting for a motivated Grievance and Appeal Intake Coordinator - Denver Health Medical Plan (Must Be A Resident of Colorado) to join our team!

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Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all :

Humanity in action, Triumph in hardship, Transformation in health.

Department

Managed Care Administration

Must Be A Resident of Colorado

Job Summary

The Grievance and Appeal Intake Coordinator ("Coordinator") works under general supervision and supports the G&A team through gathering grievances and appeals from the SharePoint log, portal submissions, email, phone and fax, inputting complaint and appeal requests within the G & A software platform. Answers the G & A phone line, providing information and assistance.

Essential Functions :

• Processes incoming submissions either by fax, phone, email, portal, or SharePoint Log (40%)
• Responds to all G&A requests, including alignment with plan benefits structure, enrollment policies, and compliance requirements, Communicates in a HIPAA-compliant and professional manner (20%)
• Answers incoming provider and member calls regarding complaints and appeals. (10%)
• Completes documentation of G&A activities in accordance with departmental procedures and in compliance with NCQA and CMS standards. (10%)
• Assigns cases to the Grievance and Appeals Specialist (5%)
• Identifies urgent requests and routes them accordingly (5%)
• Educates the provider with documentation that is needed to submit requests (5%)
• Generates and sends approved Acknowledgment letters within approved scope (5%)

Education :

Work Experience :

Licenses :

Knowledge, Skills and Abilities :

Shift

Days (United States of America)

Work Type

Regular

Salary

$22.88 - $32.03 / hr

Benefits

Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

Free RTD EcoPass (public transportation)

On-site employee fitness center and wellness classes

Childcare discount programs & exclusive perks on large brands, travel, and more

Tuition reimbursement & assistance

Education & development opportunities including career pathways and coaching

Professional clinical advancement program & shared governance

Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

Respect

Belonging

Accountability

Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.