Program Assistant X10

Department(s): Grievance & Appeals Resolution Services (GARS)
Reports to: Manager, Grievance & Appeals

The client will determine hourly rate based on experience and education within this range: Pay Range: $20.81 - $25.26/hr

Must haves: Experience & Education

• High School diploma required.
• 1 year of experience in appeal and grievance guidelines or Medical/Medicaid or Medicare programs required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Job Summary

Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent will work independently, exercising discretion and judgment and may assist in coordinating a function for the program assigned. The incumbent’s primary responsibilities will include monitoring the GARS member and provider mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe.

 

Position Responsibilities

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Serves as point of contact within or outside for inquiries related to grievances and appeals.
• Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers.
• Monitors for inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), the Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS).
• Responds to DMHC requests for information on a timely manner.
• Works with internal and external departments and providers in gathering supporting information relevant to the case.
• Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns to appropriate staff.
• Generates acknowledgment letters for all lines of business per department and regulatory standards.
• Assists in the development of departmental forms and intake process.
• Coordinates administrative support for state hearings including serving as contact with DSS for incoming cases, entering cases in the GARS system, creating electronic file and routing the scanned documents to designated staff and faxing required state hearing documentation to local hearing office as necessary.
• Completes other projects and duties as assigned.

 

Possesses the Ability To:

• Provide professional support to supervisors and staff in program to which assigned.
• Coordinate multiple administrative activities.
• Work on specialized process or function to which assigned.
• Establish and maintain effective working relationships with leadership and staff.
• Communicate clearly and concisely, both orally and in writing.
• Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment

 

Preferred Qualifications

• Bilingual in English and in one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) preferred.

 

Knowledge of:

• Services, policies and general responsibilities of program to which assigned.
• Practices and techniques required to function with professions working in assigned program.
• Methods and techniques for organizing and implementing processes.
• General information relevant to professional or administrative responsibilities in assigned program.

The Midtown Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are a small, woman-owned business certified by the Women’s Business Enterprise National Council (WBENC). Operating from our headquarters in Washington, DC, we provide trusted staffing services nationwide. Our clients include thousands of the most prestigious Fortune 500 companies, law firms, financial organizations, tech innovators, non-profits, and lobbying firms, as well as federal, state and local government agencies.