Grievance Coordinator - Part Time

AlohaCare; Honolulu (HI); On-site; USD 23,000 - 29,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401k with employer contribution

Paid time off

Referral bonus

Transportation & parking pre-tax

Job summary

AlohaCare in Hawaii is seeking a Grievance Coordinator to join the Appeals and Grievance team. You will ensure compliant, timely resolution of grievances and appeals, maintain logs, and produce required reports for QUEST Integration and CMS.

The role emphasizes customer service, accurate documentation, confidentiality, and collaboration with cross-functional teams under NCQA standards.

Qualifications

• Associates degree or equivalent combination of education and experience.
• Bachelor’s degree preferred.
• Experience with Grievance/Appeals processing or Medicaid/Medicare knowledge is preferred.
• Able to work in a fast-paced, matrixed environment and manage multiple projects.
• Strong time management, customer focus, and communication skills.

Responsibilities

• Review, research, and direct grievances and appeals to appropriate staff and track resolution.
• Maintain grievance and appeal logs and ensure timely disposition.
• Maintain electronic files and ensure accurate, policy-compliant communications.
• Prepare summaries for committee reviews and document decisions.
• Produce Grievance & Appeals reports for regulatory agencies.
• Participate in internal committee meetings and identify trends for improvement.
• Protect confidential information according to policy and law.

Skills

Interpersonal skills

Facilitation

Communication

Time management

Organizational skills

Independent work

Education

Associates degree

Bachelor’s degree

Job description

Are you ready for new challenges and new opportunities?

Join our team!

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AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Opportunity:

The Grievance Coordinator is a key member of the Appeals and Grievance team, ensuring AlohaCare members and providers of compliant, ethical, and timely resolution of their grievance or appeal. The Grievance Coordinator strives toward excellent customer service, objective research, clear documentation, and responsiveness to our concerned members or providers. Tracking and reporting grievances and appeals, the Grievance Coordinator follows regulatory requirements of Medicaid and Medicare, accreditation standards of NCQA (National Committee for Quality Assurance), internal operational policies and procedures, and AlohaCare’s high touch Care Model. Teaming up with the Grievance Lead, the Coordinator reports to the Manager of Organizational Quality Improvement and Accreditation.

Primary Duties & Responsibilities:

• Reviews, researches and directs grievances and appeal cases to appropriate staff, and follows up to ensure that resolution has occurred, documentation is complete, required timeframes are met, and proper written communication of the decision has occurred. In most cases, prepare the written communication of the decision in plain written language. Coordinates additional follow up activities with appropriate department managers and/or leads and tracks to conclusion.
• Maintains grievance and appeal logs in a timely manner for both lines of business. This includes logging incoming grievance, tracking dispositions and maintaining timeliness of resolution as required by state and federal mandates.
• Maintains electronic files of all documentation, and appropriate follow up documentation in member and provider memo screens, or other computer system modules or databases as per current workflows.
• Ensure that all information to providers, members, employees and other appropriate persons are accurate, consistent and customer sensitive.
• When needed for specific types of grievances or appeals, prepares summaries for committee review, documents meeting discussions, and communicates decision in writing.
• Prepare all Grievance & Appeals reports, as required by QUEST Integration, CMS, or other regulatory agencies per format and timeframes specified. Report drafts are prepared in advance with sufficient time for internal management review.
• Participates in internal committee and interdisciplinary meetings, reporting recent activity and analysis of trends, and makes recommendations for problem resolution and performance improvement.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Requirements:

• Associates degree or equivalent combination of education and experience.
• Minimum of 1 year of related work experience.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
• Able to work independently with minimal supervision.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Is a team player and active learner, welcoming training to improve overall performance and team productivity.
• Ability to organize and coordinate information with multiple departments and different staff levels, including management
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.

Preferred Requirements:

• Bachelor’s Degree or equivalent combination of education and experience.
• Knowledge of Medicaid, Hawaii QUEST Integration Program, and/or Medicare.
• Grievance and Appeal processing experience.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.?

Salary range: $17.00 - $21.50 an hour

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.