Member Grievance Coordinator

Colorado Access•Denver, CO

9d•Hybrid

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. What you will do: We are looking for a MEMBER GRIEVANCE COORDINATOR who can help shape our vision and support our mission. Here is what the position will look like.

Requirements

Education: High School diploma or equivalent required, or an equivalent combination of education and experience.
Experience: Requires two years of health care experience.
Knowledge, Skills, and Abilities: Knowledge of health care, Colorado Medicaid and managed care preferred. Must have excellent written and verbal communication skills. Must have strong time management skills, strong interpersonal skills and a strong working knowledge of database and spreadsheet programs, particularly Access. Requires the ability to use the grievance process and procedures to effectively facilitate timely quality outcomes. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills. Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, Outlook, SharePoint) with ability to work with a variety of project management tools. May be required to manage multiple priorities and projects with tight deadlines.
Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Nice To Haves

A bachelor’s degree in Healthcare Administration preferred.
Prefer customer service, eligibility and enrollment, grievance, behavioral healthcare or project management experience.

Responsibilities

Promptly responds to member grievances, while demonstrating compassion, empathy, respect and customer service.
Maintains record of activities through comprehensive documentation within department databases.
Responsible for logging, tracking, monitoring, resolving, auditing and reporting of member grievances.
Gathers additional information, research and investigates, to facilitate resolution of grievances.
Ensures grievances are resolved in a professional, expeditious manner, and within contractual and regulatory time limits.
Identifies potential quality of care issues and directs cases to the Quality Management Department for review as needed.
Writes and sends member response letters, and other general correspondence related to grievances, by following department guidelines, demonstrating appropriateness and utilizing approved template letters.
Recommends and manages improvements to automate processes, improve customer satisfaction and increase efficiency.
Provides internal and external training and education on the Member Grievance process.
Ensures the grievance resolution process and daily activities comply with corporate policy and procedure, ADM 203.
Monitors grievances for trends and recommends appropriate action.
Ensures grievance calls are answered from the grievance phone queue and follows department and company standards.
Provides support to the call center when needed by answering incoming calls and demonstrating a customer-focused philosophy for all customers, including but not limited to providers, members, potential members, state agencies, and other internal and external customers.
Consistently meets or exceeds performance, quality, and customer service standards as assigned by department management.
Regular Attendance and punctuality are essential functions of the job.

Benefits

We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).