Grievance Resolution Specialist Sr (provider Resolution)

CalOptima Foundation

Orange, CA, US
Base: $58,205 - $90,217; bonus/equity: not specifi...
On-site
Provider non-contracted medicare post-service appeals
Pdr in medicare and medi-cal
Medicare or medi-cal provider appeals
Join a mission-driven community-based organization that serves member health with excellence and dignity

Job Summary

  • Join a mission-driven community-based organization that serves member health with excellence and dignity.
  • This role involves coordinating the overall process of complaint resolution, responding to verbal and written complaints from members and providers, and processing complex cases.
  • The company offers competitive compensation, a comprehensive benefits package, CalPERS pension program, generous PTO, and opportunities for professional and career development.

Matching Summary

Join a mission-driven community-based organization that serves member health with excellence and dignity.

Salary

Base: $58,205 - $90,217; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package

Skills & Requirements

Must-have

  • Provider Non-Contracted Medicare Post-Service appeals
  • PDR in Medicare and Medi-Cal
  • Medicare or Medi-Cal provider appeals
  • claims administration experience

Nice-to-have

  • bilingual in threshold languages
  • health care practice standards knowledge
  • develop rapport and establish relationships

Key Requirements

  • 3 years of experience with Provider Non-Contracted Medicare Post-Service appeals and denials
  • 3 years of experience with PDR in Medicare and Medi-Cal
  • Experience with Medicare or Medi-Cal provider appeals and denials process
  • Experience in health care practice standards
  • Experience with claims administration

Work Rights

Must work within the State of California if telework approved

Tailored Resume

Cover Letter