Program Assistant

Job Description

Company Overview :   Our client is a leading healthcare located in Orange, CA, seeking Program Assistant, who will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department.

Position Summary :   The successful candidate shall have one year of relevant experience in dealing with grievance guidelines or Medi-Cal / Medicaid or Medicare programs

Job Type :   Contract

Duration :   6 months

Position Responsibilities :

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
• Serves as point of contact within or outside the organization for inquiries related to grievances and appeals.
• Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers.
• Monitors for inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), the Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS).
• Responds to DMHC requests for information in a timely manner.
• Works with internal and external departments and providers in gathering supporting information relevant to the case.
• Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns them to appropriate staff.
• Generates acknowledgment letters for all lines of business per department and regulatory standards.
• Assists in the development of departmental forms and intake process.
• Coordinates administrative support for state hearings including serving as contact with DSS for incoming cases, entering cases in the GARS system, creating electronic file, and routing the scanned documents to designated staff and faxing required state hearing documentation to local hearing office as necessary.
• Completes other projects and duties as assigned.

Possesses the Ability To :

Experience & Education :

Knowledge of :

Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”

Requirements

Provide professional support to supervisors and staff in the program to which assigned. Coordinate multiple administrative activities. Work on specialized process or function to which assigned. Establish and maintain effective working relationships with leadership and staff. Communicate clearly and concisely, both orally and in writing. Utilize computer and appropriate software (e.g., Microsoft Office : Excel, Outlook, PowerPoint, Word) and job-specific applications / systems to produce correspondence, charts, spreadsheets and / or other information applicable to the position assignment.

Salary : $23 - $30