Member Services Coordinator

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POST DATE 9/3/2016
END DATE 12/19/2016

Alignment Healthcare Orange, CA

Orange, CA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #



Responsible for providing clerical support to the Appeals and Grievance Unit as necessary to support compliance and timeliness with Appeals and Grievances within the Member Services Department.

Essential Duties and Responsibilities

Member Services

* Responsible for the daily logging, tracking, and monitoring of incoming Appeals & Grievances (CTMs, Grievances, Appeals, Fast Tracks, etc.,). Includes data entry into the A&G Member database.
* Responsible for assembly of maintaining, protecting all member A&G case files in an organized fashion.
* Responsible for the daily and timely mailing of member correspondence (i.e., acknowledgement, extension, resolution notices).
* Performs all clerical duties deemed necessary to ensure smooth functioning of the department.

5. Communicate effectively using good corporate relations.

6. Responsible for faxing grievance/appeal response requests to appropriate parties for the gathering of all pertinent and relevant information from the provider regarding the member's concerns.

7. Responsible for follow up calls to providers and/or IPA of requested documentation and that it is received timely for compliance with timelines set forth to ensure CMS compliance. All point of contacts must be logged.

8. Generate weekly departmental reports to include A or one to three months related experience and/or training; or equivalent combination of education and experience.
* _Certificates, Licenses, Registrations:_ None required.

* _Other Qualifications:_

* Knowledge Medicare Managed Care Plans.
* Good telephone techniques.
* Excellent data entry.
* Strong organizational skills.
* Bilingual (English/Spanish) required.
* Type 40 WPM (Microsoft Outlook, excel, word)
* 10-Key by Touc

Skills and Abilities

* _Language Skills:_ Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence.
* _Mathematical Skills:_ Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.

* _Reasoning Skills:_ Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.

* Excellent communication skills, oral and written.
* Excellent organizational skills
* Ability to multi-task

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

* While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
* The employee is frequently required to walk; stand; reach with hands and arms.
* The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
* The employee must occasionally lift and/or move up to 10 pounds.
* Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Working Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

* The noise level in the work environment is usually moderate.