Complaints/Appeals & Grievances Coordinator

The Complaints/Appeals & Grievances Coordinator has primary responsibility for handling member Appeals and Grievances (A&Gs) in accordance with State and Federal regulations and time frames and PrimeWest Health policy. The Complaints/Appeals & Grievances Coordinator works to administer member State Appeals (State Fair Hearings), A&Gs, and Part C and Part D processes related to data validation audits and will facilitate and ensure that PrimeWest Health's A&Gs system is in compliance with Minnesota Department of Human Services (DHS), Centers for Medicare & Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements. The Complaints/Appeals & Grievances Coordinator will present and analyze quarterly A&G and State Appeal reports for the Quality & Care Coordination Committee (QCCC) as well as for required State and Federal entities. This position will maintain documentation of State Appeals and A&Gs according to DHS and CMS standards and is also responsible for maintaining interdepartmental communication documentation and relationships with key PrimeWest Health partners. All State Appeal and A&G-related duties and responsibilities are performed in collaboration with the PrimeWest Health Chief Senior Medical Director and under the direction of the Manager of Quality Management and/or Director of Quality & Utilization Management. This individual will maintain strict confidentiality of all sensitive information.

Educational Requirements and Required Qualifications
At minimum, an associate degree or diploma in administrative assistance or two years' experience equivalent to the position requirements
Two or more years of experience with Medicaid Managed Care A&Gs is preferred
Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required. Experience in word processing and relational databases is a plus.
Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Good verbal, written, and interpersonal communication skills.
Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 30 pounds.

PrimeWest Health will accept resumes for this position until filled. No phone inquiries please. Employment to begin as soon as possible.

Qualified candidates should click "apply" to email their resume.and cover letter (Please include "Complaints/Appeals & Grievances Coordinator" in the subject line) or mail to:

Robin Zimmerman, Manager of Quality Management
3905 Dakota St
Alexandria, MN 56308

EOE