TEMP CLAIMS
Located in McMinnville, OR
Pay: $27.00 - $28.00/hour
Job Full Description
Appeals & Grievance Specialist Short-Term Position Description
Duration: 6-9 months (covering an employee leave)
Pay rate: $27-$28/hour
Summary This position is responsible for providing program support for all activities related to the Grievance System including complaints, Notice of Adverse Benefit Determination (NOABD), appeals, administrative hearings, and regulatory reporting. Utilizing project coordination principles and techniques, effect change, assist with documentation of program activities, and monitor progress and quality of outcomes. This position works closely with staff to ensure collaboration, integration, and support across all service areas.
Essential Duties
1. Works internally and with subcontractors to ensure grievance system expectations, documentation, performance, and reporting are clearly understood and provide technical assistance as needed.
2. Ensures appropriate administration of all health plan grievance system functions including preparation, submission and follow up documentation and tracking.
3. Prepares and monitors grievance system reporting and analysis activities.
Knowledge, Skills, & Abilities
• Ability to write and edit content for written reports and presentations.
• Ability to analyze, collect, prepare, and distribute appropriate materials for meetings as assigned.
• Knowledge of how to locate, assemble, edit, and summarize materials, information and data as requested.
• Excellent listening, interpersonal and customer service skills.
• Ability to establish and maintain effective, collaborative relationships with colleagues, providers, community agencies staff.
• Knowledge of Oregon Health Plan (OHP) benefit package and OHA rules and regulations.
• Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
• Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with others.
• Excellent organizational skills and ability to manage multiple tasks and timelines simultaneously, as well as to perform work with attention to detail.
• Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
• Ability to communicate effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.
• Ability to work across the Yamhill County region and to work remotely, as needed.
Education & Experience Required:
• Bachelor's degree health administration, public health, or health related field.
• Minimum of three (3) years’ medical claims processing, complaints and appeals, or health insurance industry experience.
#MacAdmin
McMinnville, OR
1949
733 Northeast Baker Street
McMinnville, OR 97128
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