Appeals & Grievance Clerk

Job Number: 5999

Workplace Type: Office Full-Time

Position Title: Appeals & Grievance Clerk

External Description:

Overview of the role:

Reporting to the Supervisor of Appeals & Grievances, the Appeals & Grievance Clerk is responsible for providing clerical support of the day-to-day operations of the Grievance and Appeals Department to achieve regulatory compliance with the Centers for Medicare and Medicaid (CMS) and other regulatory agencies.

Responsibilities:

• Timely sorts, date stamp, scan, and tracks all incoming mail.
• Assigns new complaint requests for case management into the Appeals and Grievance database, as received through multiple sources.
• Maintains filing in an organized manner, limiting access to those authorized.
• Provides support faxing appeal and grievance requests for information (i.e., medical records, provider statements, etc.,) to appropriate parties.
• Assists with making follow up calls to providers or other partners as appropriate for status updates to support timely receipt of all grievance/appeal details in a timely manner.
• Maintains confidentiality and upholds standards for privacy and data integrity and  
• security of the appeals and grievance case information.
• Maintain a positive and professional relationship with AHC staff, providers,
• members, and regulators.
• Any other duties as assigned.

Required skills and experience:

• One to two years of office setting experience.
• High school diploma or general education degree (GED).
• Basic Computer Skills, 30 WPM (Microsoft Outlook, excel, word)
• 10-Key by Touch
• Knowledge of how to work office equipment (i.e., printer, fax, scanner)
• Good Communication Skills
• Previous front office experience

Pay Range: $32,000 - $48,700 annually

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Appeals & Grievance Clerk

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].