Grievance Coordinator

Pomona Valley Corp - 1131 W. Sixth Street, Suite 350 Ontario, CAfull time

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On Site

H1B: no

Akido Labs The Grievance Coordinator manages, investigates, documents, and resolves health plan grievances, complaints, appeals support, and regulatory inquiries for clinics across the region. This role ensures timely, accurate, and compliant responses while collaborating with clinic leadership and health plans.

Responsibilities

Manage the grievance process from receipt through resolution for all assigned health plans and clinics.
Track and prioritize multiple grievance cases while ensuring compliance with turnaround time requirements.
Draft professional grievance response letters and health plan communications.
Conduct routine follow-up with clinic leadership and stakeholders regarding open grievance investigations.
Maintain grievance logs, databases, reporting tools, and supporting documentation.
Ensure complete, accurate, and timely documentation of all grievance activities.
Analyze grievance trends and identify opportunities for process improvement and member satisfaction enhancements.
Assist leadership in developing corrective action plans related to grievance findings.
Prepare recurring reports and dashboards related to grievance volume, timeliness, outcomes, and trends.
Participate in health plan meetings and delegated oversight activities as assigned.
Provide education and guidance to clinic staff regarding grievance management processes and best practices.
Support patient experience initiatives by identifying barriers impacting member satisfaction.

Qualification

Knowledge of managed careStrong analyticalExperience working with MedicareKnowledge of CMSPhysical Requirements

Required

High School Diploma or equivalent required.
Minimum of one (1) year of healthcare operations, patient relations, grievance management, quality, compliance, or health plan experience.
Experience investigating and responding to patient complaints, grievances, or regulatory inquiries.
Knowledge of managed care, healthcare operations, regulatory compliance, and health plan requirements.
Strong written communication skills with the ability to draft professional and detailed correspondence.
Excellent organizational and time management skills.
Ability to manage multiple projects and deadlines simultaneously.
Proficiency with electronic health records (EHR), Microsoft Office Suite, and reporting systems.
Strong analytical, problem-solving, and investigative skills.
Ability to maintain confidentiality and exercise sound judgment when handling sensitive information.

Preferred

Experience working with Medicare, Medicaid, Commercial Health Plans, or Delegated Medical Groups.
Prior experience in grievance and appeals management.
Knowledge of CMS, DHCS, NCQA, and health plan grievance requirements.
Experience with quality improvement and performance improvement initiatives.
Experience preparing regulatory responses and corrective action plans.
Physical Requirements:
Ability to sit and/or stand for prolonged periods of time.
Ability to move/carry objects up to 20 pounds.

Benefits

Medical

Company

Akido Labs

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Source: greenhouse

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