Join VillageCare as a Full Time Senior Grievance and Appeals Specialist, where your expertise will directly impact patient satisfaction and care quality. Enjoy the flexibility of working from home, allowing you to maintain a work-life balance while making a meaningful difference in the healthcare industry. In this dynamic role, you will tackle intricate challenges and develop innovative solutions, fostering a customer-centric environment that aligns with our commitment to excellence and integrity.\n

With a competitive salary ranging from $31.89 to $35.88 per hour, this position offers not just a job but a chance to contribute to a forward-thinking organization. You will receive great benefits such as a generous PTO package, 10 Paid Holidays, Personal and Sick time, Medical\/Dental\/Vision, HRA\/FSA, Education Reimbursement, Retirement Savings 403(b), Life and Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. This is an opportunity to collaborate with an energetic team that values your problem-solving capabilities while enhancing the overall experience for our clients. Be part of something greater-apply today!\nVillageCare: Our Story\n

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.\nWhat does a Senior Grievance and Appeals Specialist do?\n

As a Senior Grievance and Appeals Specialist at VillageCare, you will play a crucial role in ensuring that grievances and complaints are managed with precision and care. You will monitor shared mailboxes and departmental emails, ensuring that all cases are accurately entered into our tracking system and resolved in a timely manner. Your expertise will be essential in developing compliance grievance monitoring systems that meet regulatory requirements.\n

You will manage workflows to meet departmental, plan, state, and company goals while leading investigations and responses to complaints lodged with the State Department of Health and CMS. Building professional relationships with plan contacts and providers will be vital in effectively addressing member concerns, while your adherence to HIPAA and state regulations will ensure quality and compliance. By conducting ongoing audits and fostering a culture of compliance awareness, you will significantly contribute to enhancing operational excellence within our organization.\nAre you a good fit for this Senior Grievance and Appeals Specialist job?\n

To thrive as a Senior Grievance and Appeals Specialist at VillageCare, you will need a robust set of skills and experience. A Bachelor's Degree in Healthcare, or equivalent experience, is essential, with a Master's degree preferred. Candidates should possess 3-5 years of healthcare or job-related experience, including specific expertise in Managed Long Term Care. Your knowledge of the Medicare and Medicaid grievance and appeals process will be critical in navigating complex cases. Proficiency with Microsoft Excel, Word, and Outlook is a must, ensuring you can efficiently manage documentation and communications.\n

Excellent verbal and written communication skills will aid you in effectively handling member inquiries and complaints. Additionally, strong organizational skills are necessary to prioritize and manage multiple tasks amidst tight deadlines and frequent interruptions. This role requires a proactive problem-solver who can maintain focus on delivering exceptional service while adhering to regulatory standards.\nYour next step\n

If you feel that this job is what you're looking for, applying is a piece of cake - just follow the instructions on this page. Good luck!\n

VillageCare is an Equal Opportunity Employer.