Appeals & Grievances Support Coordinator, remote

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

The Appeals & Grievances Support Coordinator will be responsible for providing administrative support to the Appeals and Grievance Department and ensuring that both member and provider grievances and appeals, meet all regulatory requirements as instructed by Medicaid, Medicare and Commercial business.

The Appeals and Grievances Support Coordinator is encouraged to intake all grievances and appeals and ensure that each step in the workflow itinerary, from intake to resolution, is done accurately and within the time frames allotted. The A&G Support Coordinator should also collaborate with A&G leadership on the identification and areas for improvement and provide recommendations on ways in which to be more efficient and accurate, especially as the complexity or workload increases.

The ideal candidate will be organized, able to anticipate the needs of the staff they support and be able to support cross-functional coordination in a fast-paced environment.

Position Responsibilities:

• Responsible for coordinating time-sensitive appeals and grievance activities, including, but not limited to, tracking all member appeals and grievances in the systems provided, assigning them to the appropriate coordinators, ensuring that all appeals and grievances meet their administrative due dates, and facilitating communication between parties, whether they be internal or external customers.
• The Appeals and Grievances Support Coordinator is also encouraged to prepare all the various communications for the coordinators, medical directors, pharmacy team, and compliance team, to ensure everyone’s roles and responsibilities are very clear when facilitating these communications.
• This position will work in collaboration with the Appeals and Grievance Coordinators, as well as Medical Directors to provide follow-up and outreach to members and providers when additional information is necessary.
• The coordinator will also play a pivotal role in the communications amongst internal departments as well as external vendors and help put together any reporting or information during any audits or other oversight actions.
• The coordinator is encouraged to be highly organized and able to multi-task as priorities shift within the department, as well as outside the department.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications:

• High school diploma, plus 5 years of clerical experience or two or more years’ experience working in a health plan in an administrative role and/or within customer service
• Knowledge of appeals and grievances within a health plan preferred
• Bilingual (preferred – Spanish)

Skills/Competencies:

• Excellent time management
• Ability to work independently
• Ability to make some decisions within department guidelines
• Ability to work in a fast-paced team environment
• Attention to detail with emphasis on accuracy and quality
• Ability to prioritize work to balance multiple projects and deadlines
• Excellent verbal and written communication
• Under direct supervision of the Director of Appeals and Grievances, this individual should be self-motivated and assume responsibility and ownership of responsibilities.
• This position reports to the Director of Appeals and Grievances and interacts with internal and external stake holders.
• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.