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The Grievance Coordinator position at Central California Alliance for Health involves working within the Member Services Department to assist in the administration and resolution of grievances related to healthcare services. This role is crucial in ensuring that member complaints and provider disputes are handled efficiently and within regulatory timeframes. The Grievance Coordinator will be responsible for tracking, organizing, monitoring, and following up on case work, which includes low complexity cases that support the Alliance's grievance function. The Grievance team is specialized in handling various types of grievances, including member complaints, expedited complaints, appeals, state fair hearings, inquiries, complex billing issues, and provider disputes. Each of these areas requires a nuanced understanding of healthcare regulations and the ability to communicate effectively with members and providers. The role demands participation in departmental and cross-departmental trainings and operational improvement activities to enhance the grievance resolution process. To be successful in this position, the Grievance Coordinator must possess knowledge of managed healthcare principles, Title 22 and Title 28 regulations, and customer service practices. The ability to draft professional correspondence, navigate computer systems, and work independently or as part of a team is essential. The position requires an Associate's Degree in health, social services, or a related field, or Medical Assistant certification, along with at least one year of experience in a managed healthcare setting or a related field.
