Appeals and Grievances Coordinator

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.

One Community. One Mission. One California 

***This position is hybrid in-office and work from home.

Position Summary:

The Appeals and Grievances Coordinator is responsible for supporting the appeals department team members by managing and coordinating the appeals and grievance process. This role involves:

- facilitating delivery of member and provider complaints

- ensuring compliance with regulatory requirements

- facilitating timely and effective resolution of appeals and grievances.

Acting a subject matter expert (SME), the Coordinator will work closely with internal teams and external stakeholders to ensure a high level of service and satisfaction.

This position oversees a mix of operational, business and regulatory activities related to several Health Plan Partnerships. This position will work closely with health plan partners to ensure a seamless transition in implementing new and ongoing regulatory requirements. From a business perspective, this role is responsible for the ongoing delegation and performance of our contractual obligations with our Health Plan partners.

Minimum Qualifications:

- 2+ years administrative experience in a compliance auditing arena. Previous experience in a similar administrative or coordination role.
- Associates degree or 3 years of related job or industry experience in lieu of degree
- Familiarity with healthcare regulations, including HIPAA, CMS, and state-specific requirements

Preferred Qualifications:

- 2 years managed care experience preferred
- 1 year delegation oversight experience preferred
- Regulatory audit experience preferred
- Bachelors degree or 5 years of related job or industry experience in lieu of degree preferred
- Certified Compliance Professional (CCP) Certified Professional in Healthcare Quality (CPQH) Certified Healthcare Auditor (CHA) preferred
- Knowledge of DMHC, NCQA, CMS and other regulatory bodies preferred
- Knowledge of HIPPA, managed care environment preferred
- Strong technical proficiency in data analysis; database software preferred
- Familiarity with compliance requirements is a plus