Grievance and Appeals Lead- Remote

Date: Mar 18, 2023

Location:

Any city, OH, US, 99999

Req ID: 16267

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Grievance and Appeals Lead is responsible for developing and maintaining policies and procedures for the grievance and appeals system, monitoring performance, ensuring compliance with state-defined policies, and meeting regulatory requirements. They will also facilitate improvements, train staff, and work with other Ohio entities. Other duties may be assigned.

Your role in our mission

Develop and maintain written policies and procedures for the grievance and appeals system for members and providers.
Meet all the G&A system requirements including the Notice of Action in accordance with federal standards.
Maintain files on individual grievances and appeals.
Fully engages in real-time performance monitoring to facilitate achievement of service level agreement requirements.
Ensures both verbal and written inquiries and issues are researched and resolved in compliance with state-defined policies, procedures, and criteria.
Ensures clinical, operational, and experiential standards are met.
Ensures Gainwell staff are initially trained and works with the Training Coordinator to assess ongoing training needs.
Meet all logging and reporting regulatory requirements for grievances, appeals and state hearings according to state and federal requirements.

What we're looking for

Six or more years of customer service or other telephone experience
One or more years of Grievance and Appeals experience preferred
Experience with Medicaid preferred
Experience working with and skilled in the use of help desk software preferred
Experience working with organizational functions and personnel

What you should expect in this role

This is a 100% remote position.

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The pay range for this position is $49,200.00 - $70,300.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.