Position: Grievance/Appeals Specialist

Category: Non -Exempt

Location: TBD (Can be at any of the four sites)

Salary Range: $41,026 - $51,236

Closing Date: Wednesday, April 12, 2023 at 5:00 pm

Position Number: 17-40-1007

Position Description: Assist Medicaid and State funded services providers with enrollment, service authorization, contracting or reimbursement questions or issues. The Grievance and Appeals Specialist receives and documents grievances/complaints and appeals from members, recipients, stakeholders, providers/practitioners, Eastpointe staff, families, and legal guardians. Attempts to identify facts and appropriate resolution with the involved party(ies) by performing the following duties.

Responsibilities and Duties:

• Employee provides direct case resolution and advocacy on grievances/complaints from members, recipients, stakeholders, providers, Eastpointe staff, families, legal guardians, the Department, and anonymous sources.
• Employee shares the responsibility with other Grievance and Appeal staff in answering the Grievance/Complaint Queue-Line. The employee is prompt and courteous in answering all incoming calls regarding Medicaid and State funded grievances/complaints and appeals.
• Employee may also assist with provider questions, comments, inquiries and grievances/complaints related to the Tailored Plan.
• With consultation with Director of Grievance and Appeals, employee will be required to analyze situation, determine appropriate agency, MCO and/or Eastpointe Department to contact for resolution of the reported issue.
• Employee will provide technical assistance, training, and consultation to members/recipients, stakeholders, providers, Eastpointe staff, families, legal guardians on interpretation and application of client rights, grievance process, non-Medicaid Appeal process, complaint procedures, and the dispute resolution process.
• The employee must demonstrate the ability to investigate and/or assess the need for investigative actions; collect, document, and analyze details of data gathered, draw valid conclusions, translate/summarize clinical findings, interpret technical material, and prepare concise and accurate written investigative reports and/or resolution letters.
• Employee ensures complaint/grievance data is documented and entered into data base with 90%accuracy.
• Employee follows and adheres to all established timeframes as required by the state and Contract.
• Other duties may be assigned as determined by the Director or Chief of Quality Management.
• Based on results of investigation, employee prepares correspondence, notifications, maintains complete and accurate record of all actions taken.

Education/Experience/Licensure: Master's degree in psychology, social work, education, health, business administration or related human service field and one year of experience in professional level treatment programming for the applicable client population; or a bachelor's degree in one of the fields listed above and two years of experience as indicated above; or an equivalent combination of training and experience.

Excellent Benefit Package to Include:

• Employer paid Health, Dental, Life and Long Term Disability Insurance
• NC Local Government Retirement System
• NC 401K with 4% employer match
• 13 paid holidays per year
• Monthly sick and vacation leave earnings