Job Description

Apply on line at http://www.alohacare.org/Careers/Default.aspx The Company: AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii?s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii. The Culture: AlohaCare employees share a passion for helping Hawaii?s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package. AlohaCare?s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii?s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare?s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program. These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve. Position Summary of a Grievance Coordinator : The Grievance Coordinator is a key member of the Appeals and Grievance team, ensuring AlohaCare members and providers of compliant, ethical, and timely resolution of their grievance or appeal. The Coordinator strives toward excellent customer service, objective research, clear documentation, and responsiveness to our concerned members or providers. Tracking and reporting grievances and appeals, the Coordinator follows regulatory requirements of Medicaid and Medicare, accreditation standards of NCQA (National Committee for Quality Assurance), internal operational policies and procedures, and AlohaCare?s high touch Care Model. Teaming up with the Grievance Lead, the Coordinator reports to the Manager of Organizational Quality Improvement and Accreditation. Primary Duties & Responsibilities of a Grievance Coordinator : ? Reviews, researches and directs complaints, grievances and appeal cases to appropriate staff, and follows up to ensure that resolution has occurred, documentation is complete, required timeframes are met, and proper written communication of the decision has occurred. In most cases, prepares the written communication of the decision in plain written language. Coordinates additional follow up activities with appropriate department managers and/or leads and tracks to conclusion. ? Maintains grievance and appeal logs in a timely manner for both lines of business. This includes logging incoming grievance, tracking dispositions and maintaining timeliness of resolution as required by state and federal mandates. ? Maintains electronic files of all documentation, and appropriate follow up documentation in member and provider memo screens, or other computer system modules or databases as per current workflows. ? Ensures that all information to providers, members, employees and other appropriate persons is accurate, consistent and customer sensitive. ? When needed for specific types of grievances or appeals, prepares summaries for committee review, documents meeting discussions, and communicates decision in writing. ? Prepares all Grievance & Appeals reports, as required by QUEST Integration, CMS, or other regulatory agencies per format and timeframes specified. Report drafts are prepared in advance with sufficient time for internal management review ? Participates in internal committee and interdisciplinary meetings, reporting recent activity and analysis of trends, and makes recommendations for problem resolution and performance improvement ? Other duties as required ? Responsible to maintain AlohaCare?s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title Required Qualifications of a Grievance Coordinator: ? Associate?s Degree or equivalent combination of education and experience ? 1 - 2 years of related work experience ? Demonstrates an appropriate level of verbal and written communication in English. ? Requires operation of general office equipment to include; PC, fax/copy machine and ACD Midel Phones and working knowledge of Microsoft Office tools ? Achieves results, builds trust, communicate effectively, customer and quality focused. ? Team player and active learner, welcoming training to improve overall performance and team productivity. ? Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment. ? Ability to organize and coordinate information with multiple departments and different staff levels, including management ? Demonstrates skills in problem solving and customer service ? Is a self-starter. ? Experience with utilizing multiple data bases ? Engages in Process Improvement Preferred Qualifications of a Grievance Coordinator : ? Health plan experience ? Knowledge of Medicaid, Hawaii QUEST Integration Program, and/or Medicare ? Grievance & Appeal processing experience ? Bachelor?s Degree Physical Demands/Working Conditions:

• Inside working conditions

• No environmental hazards

• Ability to conduct training; potentially with audiovisual presentations

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.

Salary range: $16.50 ? 21.00 an hour AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders. Job Type: Full-time Pay: $16.50 - $21.00 per hour Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Honolulu, HI 96814: Reliably commute or planning to relocate before starting work (Required)

Experience:

• related work: 1 year (Required)

Work Location: In person