We are actively seeking a Member Relations Specialist for a thriving healthcare organization in Sacramento, CA. The MRS is responsible for meeting all regulatory guidelines and timeframes with regards to appeal/grievance case processing for our organizaitons. This includes working knowledge of the Department of Managed Healthcare (DMHC) regulations pertaining to appeals and grievances and Privacy Practices for the Use and Disclosure of Protected Health Information (PHI) regulations, with regards to member information and medical records. Please read the job responsibilities and requirements sections below and reply immediately if interested!
Provide timely communications (written and verbal) to Members, Medical Groups, Providers, and the DMHC while maintaining accuracy at all times
Act as the initial point of contact regarding member issues related to appeals/grievances and effectively represent Member’s interest
Maintain accurate documentation throughout the entire process.
Prepare and maintain Member Issue case files for initial prioritization
Follow-up on all appeals/grievances of triage
Maintain accurate and timely appeal panel documentation
Customize written acknowledgement and resolution letters to include case specifics which are established on a determination of benefit guidelines and/or medical necessity.
Generate written case summaries, prepare case files, and handle closure of appeals and/or grievances
High School Diploma.
2 years’ related experience
Experience with claims adjudication and referrals and authorizations preferred.
Previous experience working in the health care industry; preferably HMO
Intermediate computer skills, including e-mail, routine database activity, word processing, spreadsheets etc
Please send your resume directly to Andrew Walsh at Andrew.Walsh@accountingprincipals.com if you are interested in Member Relations job in the Sacramento area or apply directly to this posting. Interviews currently being scheduled in our Sacramento Office and will be starting soon. You can see our other current job openings at www.accountingprincipals.com.