REMOTE Medicare Grievance Analyst

Now hiring a Remote Medicare Grievance Analyst in Grand Rapids, MI. This Medicare Grievance Analyst position requires prior Medicare grievance experience and has career growth potential. This would be full time / 40+ hours per week. States not eligible for remote work include CA, CT, MA, NJ, NY, and Washington D.C.

If interested, please apply!

Corrin Misak - Staffing Manager II
A-Line Staffing Solutions
cmisak@alinestaffing.com or (586) 710-7958

Medicare Grievance Analyst Overview:

• Remote work for this position may be approved based on policy and business considerations. Some states are not eligible for remote work (CA, CT, MA, NJ, NY, Washington D.C.)
• SUMMARY: The Grievance Analyst makes decisions on moderately complex issues and work is performed without direction. Exercises latitude in determining objectives and approaches to assignments. Responsible for the analysis, research and completion of complex member grievance investigations. Effectively administer all steps of the member grievance. Thoroughly investigate member grievances, leveraging critical thinking skills, gathering relevant information from enterprise-wide systems, and collaboration to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory and accreditation requirements. Assist members and staff throughout the process by providing complete information and follow up on a timely basis. Ensure committee, State and Federal decisions are properly implemented. Assist the Supervisor and/or Manager in coordinating activities and in the development/collection of materials required to meet and demonstrate compliance to all state, federal and accrediting organization requirements.
• Pay Rate: $19-$22/hour, paid biweekly
  • Benefits are available to full-time employees after 90 days of employment
  • A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates
• This position is a W2 contract assignment
  • 3 month assignment to start
  • Opportunity to extend to 6 months

Medicare Grievance Analyst Responsibilities:

• Responsible for complex and thorough investigation of grievances: formulate action plan to ensure all activities are completed by the regulatory time line, gather all relevant information for the grievance captured (internal documentation from enterprise-wide systems including: claims payments, billing and enrollment, care management, medical, pharmacy and behavioral health authorizations, customer service interactions, prescription claims, medical policies, and plan documents).

• Track all activity including communication for each grievance by entering complete documentation of issues and related follow-up, ensuring all customers receive required correspondence according to time line requirements and to ensure all regulatory reporting requirements are met.

• Conducts root cause analysis to determine corrective actions related to the grievance process by researching systemic issues to determine course corrections.

• Perform quality assurance reviews for case files, decision forms, documentation and logs to ensure they are complete, organized and secure and ensure all procedures are followed and time line requirements are met, including implementation of relevant Committees as needed.

• Support with providing education and communicates training needs to Customer Service Leadership, when appropriate.

• Collaborate with cross-functional departments to implement improvements to member experience, medical policies, legal documents, member materials, departmental processes and workflow.

• Support in conducting root cause analysis to determine corrective actions related to the grievance process by researching systemic issues to determine course corrections

• Apply strong analytical skills and business knowledge to investigation, analysis and recommendation of solution Communicates, collaborates and acts as a consultant to internal and external customers in order to resolve complex issues.

Medicare Grievance Analyst Qualifications:

• Minimum High school diploma or equivalent
• Two years of medical grievance research and analysis experience (Knowledgeable on Medicare)

If interested, please apply to this job posting right away. I look forward to hearing from you!
Corrin Misak - Staffing Manager II
A-Line Staffing Solutions
cmisak@alinestaffing.com or (586) 710-7958