Sharp HealthCare

Appeals/Grievance Coordinator I - SHP Operations - Remote - Day Shift - Full Time

REMOTEPosted 25 days ago

Job summary

  • Job post source

    This job is directly from Sharp HealthCare

  • Job overview

    The Appeals/Grievance Coordinator I at Sharp HealthCare manages commercial member appeals and grievances to ensure compliance with legal, regulatory, and company standards, impacting member satisfaction and regulatory adherence.

  • Responsibilities and impact

    The role involves investigating, documenting, and resolving appeals and grievances, maintaining case files, providing customer service, supporting audits and workgroups, preparing reports, and conducting interdepartmental research to resolve issues.

  • Compensation and benefits

    The hourly pay range is $29.41 to $44.11, with actual pay depending on experience and skills; benefits details are not specified.

  • Experience and skills

    Requires 3 years of experience in claims, utilization review, appeals, or member services in managed care; a bachelor's degree in business or healthcare administration is preferred; skills include knowledge of managed care principles, regulatory standards, data analysis, communication, and computer proficiency.

  • Work environment and culture

    Sharp HealthCare promotes ethical practices, integrity, innovation, teamwork, and professionalism in a results-oriented environment.

  • Company information

    Sharp HealthCare is a healthcare organization based in San Diego, providing health plan services and complying with state and federal regulations.

  • Job location and travel

    The position is remote with a day shift based in San Diego, California, with variable shift times and occasional weekend work as needed.

  • Unique job features

    The job includes working closely with medical and operations leadership, supporting regulatory audits, and handling both clinical and non-clinical appeals and grievances.

Company overview

Sharp HealthCare is a leading not-for-profit health care system based in San Diego, California, providing a wide range of medical services including acute care, rehabilitation, behavioral health, and home health services. The organization generates revenue through patient services, insurance reimbursements, and various health programs. Founded in 1955, Sharp HealthCare is known for its commitment to clinical excellence and patient-centered care, and it operates several hospitals and medical centers across the region. The company has received numerous accolades for quality and innovation in health care, making it a reputable employer in the industry.

How to land this job

  • Position your resume to highlight your experience in appeals, grievances, claims, or member services within a managed care environment, emphasizing compliance with state and federal regulations and accreditation standards like NCQA.

  • Focus on showcasing your ability to manage case files, document thoroughly, and communicate professionally with members, providers, and regulatory agencies, as well as your skills in data analysis and report preparation.

  • Apply through multiple platforms including Sharp HealthCare's official corporate careers site and LinkedIn to maximize your application visibility and ensure your resume reaches the right hiring managers.

  • Connect on LinkedIn with professionals in Sharp HealthCare's Health Plan or SHP Operations divisions; start conversations by referencing recent regulatory changes in managed care, expressing interest in their work on appeals and grievances, or asking about the team culture and challenges.

  • Optimize your resume for ATS by incorporating key phrases from the job description such as 'appeals and grievances processing,' 'NCQA accreditation standards,' 'managed care environment,' 'regulatory compliance,' and 'case file documentation' to enhance keyword matching.

  • Utilize Jennie Johnson's Power Apply feature to automate tailored resume formatting, multi-channel applications, and LinkedIn networking outreach, allowing you to focus your time on preparing for interviews and refining your candidacy.

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