Coordinator, Medicare Complaints, Appeals & Grievances (MCAG)

Sonder Health Plans Remote

Salary Range: $45,000 - $55,000 /yr # of positions: 1

Job Description

Job Summary
Responsible for the intake of Medicare Complaints, Appeals & Grievances (Member & Provider), in accordance with any contractual obligations, internal written standards and any applicable requirements established by the Centers for Medicare and Medicaid (CMS). Intake Coordinators prepare case files for Specialist and/or Clinical Reviewer processing and may assist with closing case files with proper documentation to ensure completeness of reviews.

Knowledge/Skills/Abilities

• Responsible for intake, of all complaints, appeals and grievances from Sonder members and related outside agencies, while maintaining confidentiality in accordance with CMS guidelines.
• Responsible for intake, of all Non-Contracted Provider appeals from Sonder members and related outside agencies, while maintaining confidentiality in accordance with CMS guidelines.
• Responsible for intake, of all Contracted Provider appeals from Sonder Participating Providers and related outside agencies, while maintaining confidentiality in accordance with Sonder Health Plans contractual obligations with that provider.
• Ensures all cases have been organized, categorized and reported correctly.
• Prioritize and organize tasks to meet compliance deadlines.
• Assures timeliness and appropriateness of the intake process in accordance with state, federal and Sonder Health Plans’ policies and procedures as applicable.
• Prepares summaries, correspondence and documents for tracking/trending data when preparing case files for Specialist and Clinical Reviewer processing.
• Assists with closing case files with proper documentation to ensure completeness of reviews to meet any compliance standards.
• Ability to meet established productivity, schedule adherence, and quality standards.
• Communicates with the management team to correct problems ensuring customer satisfaction.
• Reliably and consistently meets work schedules, productivity requirements and deadlines.
• Attends meetings as required; Participates in employee orientation and training.
• Performs and assists in other duties and special projects as required.

Job Qualifications

Required Education
High School Diploma or GED

Required Experience
Any Medicare Managed Care experience.

Preferred Education
Associate's/Bachelor's Degree or minimum of 1 years' experience working with managed care plans.

Preferred Experience
Any medical office experience

Experience with Centers for Medicare & Medicaid Services (CMS) systems and processes

Familiarity with Medicare claims denials and appeals processing, and CMS guidelines for appeals, denials, and grievances.