Appeals & Grievances Coordinator I

MedImpact Healthcare Systems, Inc.•San Diego, CA

1d•$18 - $28•Hybrid

About The Position

The Appeals & Grievances Coordinator I is a key member of MedImpact Healthcare Systems’ Appeals and Grievances team, which manages intake, processing, notification, and compliance for appeal and grievance requests. The Coordinator processes requests according to accuracy, timeliness, productivity, client commitments, and applicable regulatory requirements. The position works under general supervision, using work instructions, policies, procedures, and company resources, and reports directly to the Supervisor of Appeals and Grievances Operations. The Lead Coordinator (Coordinator III) leads the team. The role uses business applications, including MedAccess, MedResponse, FileNet, and RightFax, to review information and enter data. It requires reasoning, multitasking, cross-training across appeals and grievances, and interaction with internal and external customers. The Coordinator participates in a rotating weekend on-call schedule as needed and must be flexible when shifts change. This is a full-time, non-exempt position. Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; overtime, nights, weekends, or holidays may be required to meet business needs. The position is on-site at the San Diego headquarters or another company location, with remote work possible with management approval based on business requirements. No travel is required, although attendance at local conferences or meetings may be requested.

Requirements

GED or high school diploma and at least 1 year of experience, or an equivalent combination of education and experience.
State licensure as a Pharmacy Technician is required.
Knowledge of the MS Office Suite, with proficiency in Microsoft Word and Microsoft Excel.
Clear oral and written communication skills, including the ability to listen, obtain clarification, write simple correspondence, and present information to customers, clients, and colleagues.
Ability to follow detailed written or oral instructions, solve problems, collect data, establish facts, and draw valid conclusions.
Ability to perform basic arithmetic and apply fractions, percentages, ratios, and proportions to practical situations.
Ability to balance team and individual responsibilities, follow policies and procedures, and complete tasks correctly and on time.
Ability to work overtime and, as required, nights, weekends, or holidays; flexibility to accommodate shift changes.
Ability to meet the physical demands of the position, including occasionally lifting or moving up to 25 pounds.

Nice To Haves

Certified Pharmacy Technician certification.

Responsibilities

Evaluate and process appeals and grievances according to established work instructions and approved departmental documents.
Conduct and document outreach, including outbound calls and faxes, to obtain information needed for processing or to communicate review results.
Finalize appeals and grievances within required turnaround times and in accordance with applicable laws and company policies.
Cross-train across appeal and grievance task divisions.
Participate in the rotating weekend on-call schedule as needed.
Protect the confidentiality and privacy of members’ personal and health information in accordance with federal requirements and company policies.
Comply with company and department policies, procedures, rules, and regulations.
Adapt to departmental changes and business needs, including shift changes.
Provide customer service and communicate effectively with internal and external clients, respond to client needs and service requests, solicit feedback, manage difficult situations, and meet client commitments.