What are the responsibilities and job description for the Coordinator, Medicare Complaints, Appeals & Grievances (MCAG) position at Sonder Health Plans?
Coordinator, Medicare Complaints, Appeals & Grievances (MCAG)
Sonder Health Plans Remote
Salary Range: $45,000 - $55,000 /yr # of positions: 1
Job Description
Job Summary
Responsible for the intake of Medicare Complaints, Appeals & Grievances (Member & Provider), in accordance with any contractual obligations, internal written standards and any applicable requirements established by the Centers for Medicare and Medicaid (CMS). Intake Coordinators prepare case files for Specialist and/or Clinical Reviewer processing and may assist with closing case files with proper documentation to ensure completeness of reviews.
Knowledge/Skills/Abilities
- Responsible for intake, of all complaints, appeals and grievances from Sonder members and related outside agencies, while maintaining confidentiality in accordance with CMS guidelines.
- Responsible for intake, of all Non-Contracted Provider appeals from Sonder members and related outside agencies, while maintaining confidentiality in accordance with CMS guidelines.
- Responsible for intake, of all Contracted Provider appeals from Sonder Participating Providers and related outside agencies, while maintaining confidentiality in accordance with Sonder Health Plans contractual obligations with that provider.
- Ensures all cases have been organized, categorized and reported correctly.
- Prioritize and organize tasks to meet compliance deadlines.
- Assures timeliness and appropriateness of the intake process in accordance with state, federal and Sonder Health Plans’ policies and procedures as applicable.
- Prepares summaries, correspondence and documents for tracking/trending data when preparing case files for Specialist and Clinical Reviewer processing.
- Assists with closing case files with proper documentation to ensure completeness of reviews to meet any compliance standards.
- Ability to meet established productivity, schedule adherence, and quality standards.
- Communicates with the management team to correct problems ensuring customer satisfaction.
- Reliably and consistently meets work schedules, productivity requirements and deadlines.
- Attends meetings as required; Participates in employee orientation and training.
- Performs and assists in other duties and special projects as required.
Job Qualifications
Required Education
High School Diploma or GED
Required Experience
Any Medicare Managed Care experience.
Preferred Education
Associate's/Bachelor's Degree or minimum of 1 years' experience working with managed care plans.
Preferred Experience
Any medical office experience
Experience with Centers for Medicare & Medicaid Services (CMS) systems and processes
Familiarity with Medicare claims denials and appeals processing, and CMS guidelines for appeals, denials, and grievances.
Salary : $45,000 - $55,000
