Compliance Grievance Coordinator (Remote)

POSITION:Compliance Grievance Coordinator

SALARY: DOE

REPORTS TO: Compliance Officer with dotted line to Compliance Manager

POSITION DESCRIPTION:

Responsible for analyzing, resolving, expediting, and coordinating the processing of telephone, electronic and written inquiries. Providing job and team specific support and coaching for customer service and other team members. Will also be cross trained and serve as a departmental support person for Compliance, Privacy and PI/QM functions and projects.

ESSENTIAL FUNCTIONS:

• Logs, tracks, and processes grievances.
• Sets up and maintains case files for each grievance and collects the information required by organizational policies and applicable regulations.
• Conducts research, provides additional education and coordination needed to evaluate, process, respond to, and refer or close grievances with the various tango business units.
• Track and monitoring of business and operations activities for compliance with internal audit process and external health plan and regulatory rules and regulations.
• May assist in upload of monthly, quarterly, and annual reports to secure sites while maintaining high accuracy, timeliness, and security of the data.
• Communicates, interacts, and work well with internal teams including compliance team and business partners.
• Coordinates and prepares health plan letter and reporting templates for integration and use by IT, Compliance and applicable business partners.
• Researches and files various licensure of tango in new state. Updates and assists in tracking of licenses specific to State guidelines and includes clinician licenses.
• Coordinates, puts together files and/or submits deliverables for internal/external audits, CAPs, Compliance, Privacy/Security and PI/QM projects.
• May assist in annual policy reviews/attestation process, makes policy revisions as directed, keep policies organized, revised, and updated in compliance with regulatory and specific contract requirements.
• Compiles monthly/quarterly Compliance reports/data, put in pivot tables and graphs within Excel and tracks end-to-end reporting requirements, updating job-aides, workflow processes, etc.
• Works well under deadlines and meets required timeframes.
• Performs other duties as assigned.

KNOWLEDGE AND EXPERIENCE:

• Two years of customer service experience in a health care or insurance environment.
• Experience evaluating customer situations, making decisions, and responding quickly to questions.
• Experience handling escalated customer issues from business teams.
• Clear and concise verbal and excellent written communication skills.
• Interpersonal and analytical skills.
• Data entry and/or typing experience.
• Healthcare industry experience and knowledge of medical terminology
• Proficiency in Microsoft Office Applications including Excel, PowerPoint, Adobe, Share Point, and Word.
• Organized, detail oriented, and ability to multi-task competing priorities.
• Project management skills preferred.

EDUCATION AND EXPERIENCE:

• Two years of experience in Customer Service, Credentialing, Billing/Claims, Project Management, or related environment preferred
• High school diploma or GED equivalent
• 1+ year grievance experience
• 1+ year Medicare experience
• 2 years of data entry experience in an office environment.
• Knowledge of medical terminology

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.