You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Join our client as a Grievance and Appeals Coordinator, where you will be responsible for managing and documenting health plan appeals and grievances. Your role will involve working closely with providers and internal and external partners to gather required information on time. You will also make daily calls to provider offices, coordinate outpatient surgery locations, and review new referrals to ensure member eligibility updates. Additionally, you will assist in reviewing and improving processes, maintaining policies and procedures, and taking on additional projects as needed.

Responsibilities / Job Duties

• Manage and document health plan appeals and grievances with providers and partners.
• Make daily calls to provider offices to coordinate outpatient surgery locations and review new referrals.
• Proactively follow up with providers and partners to ensure accurate documentation.
• Help review and improve current processes for efficiency and quality.
• Assist with maintaining policies and procedures for appeals, grievances, and referrals.
• Take on additional projects and tasks as needed.

Minimum Education and Experience Qualification Requirements

Qualifications

• Strong experience in Appeals and Grievances preferred; some understanding necessary.
• Minimum 2 years’ experience in health care related to grievances, care coordination, or member services.
• Excellent verbal and written communication skills.
• Experience with Health Services or physician office a plus.
• Proficient with Microsoft Office tools: Word, Excel, and PowerPoint.

Experience

• Minimum 2 years’ experience in relevant healthcare field.
• Experience with member and provider outreach activities.

Skills

• Technical proficiency in Microsoft Office tools: Word, Excel, and PowerPoint.
• Excellent verbal and written communication skills.
• Ability to multi-task while on the phone.

Schedule / Shift

8:30am-5pm Monday-Friday with potential flexibility after training. Initial three months fully in office, with potential for hybrid work afterward.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients