Central California Alliance for Health - Grievance Supervisor

• To read the full position description, and list of requirements click here. • Knowledge of: • The principles and practices of healthcare coverage and benefit structures, the principles of coordination of benefits, and medical billing • Medi-Cal program and related regulations • Title 22 and Title 28 utilization management and grievance regulations • Principles and practices of customer service • Principles and practices of managed health care • Ability to: • Act as technical resource and explain regulations, processes, and programs related to area of responsibility • Learn, interpret, and apply Medicare D-SNP regulations and act as a subject matter expert on D-SNP within the Grievance Unit • Supervise, train and evaluate the work of staff • Motivate staff and promote an atmosphere of teamwork and cooperation • Plan, organize and prioritize tasks and work schedules, manage projects, and adhere to timelines • Identify issues, conduct research, gather and analyze information, reach logical and sound conclusions, and make recommendations for action • Bachelor’s degree in Social Sciences, Health, Business or a related field • Four years of experience in a managed health care environment performing work related to billing, claims payment, coding or a closely related function, including some lead or supervisory experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying • OTHER INFORMATION • We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.