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Compliance Coordinator - Appeals & Grievance/Utilz. Mgmt.

Send to my Email Email a friend Job ID 75986 Date posted 09/14/2016
Requisition ID: 75986
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Operations
  • Category: Business Operations Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: 8 AM
  • Shift End Time: 5 PM
Location
This position is located in Kearny Mesa, San Diego County
 
Hours
 8am-5pm; Weekends as needed
 
Required Skills and Qualifications
  • High school diploma or equivalent
  • Requires 3-5 years’ experience in managed care environment with specific experience related to Appeals & Grievances and/or Health Services Management
  • Expertise in health plan, state & federal regulatory compliance related to managed care, approval, denial, appeals and related
  • Proficiency with MS Word 
  • Accurately type at least 45 wpm
  • Requires excellent communication skills, including the ability to communicate clearly and professionally, both verbally and in writing
  • Ability to analyze, organize, identify and prioritize multiple projects
Preferred Skills and Qualifications
  • AA or college course work in health care business administration
  • Completion of Medical Terminology course
  • Utilization Management (UM) correspondence
  • Experience with using Global Works or Optum letters
  • Proficiency in the use of GE Centricity 
  • Proficiency with Excel and Access software applications 

Summary
The Compliance Coordinator will ensure compliance with all State, Federal and Health Plan requirements for correspondence to communicate Appeal & Grievance (A&G) and Utilization Management (UM) decisions to include denials to members and providers.  Responsible for ensuring accuracy and compliance of A&G logs, databases and case files, as assigned.  Provides support for A&G case follow-up.

Sharp Health Plan is San Diego’s only locally based commercial health plan. With a personal approach and a superior network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.

As one of the top-rated health plans in California (as measured by the CAHPS satisfaction survey), Sharp Health Plan serves a growing number of companies, large and small, in San Diego and southern Riverside counties.

Additional physical requirements of position may be discussed during interview.

Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.

Keywords: Health Plan, Managed Care, Appeals & Grievance, Compliance Coordinator
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