Grievance and Appeals Coordinator II / Req 956599811
Alameda Alliance for Health · Alameda, CA · 1 mo ago
Healthcare$30.26–$45.4/hrFull-time
We need to output HTML fragment with headings for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes: Brief Description (Hybrid: Applicants must be a California resident as of their first day of employment.) That's like About the role? Could be "About the role". Then "PRINCIPAL RESPONSIBILITIES:" with many bullet-like sentences. Then "Essential Functions Of The Job" (maybe also responsibilities). Then "Physical Requirements". Then "Number of Employees Supervised: 0". Then "MINIMUM QUALIFICATIONS:" with education, experience, special qualifications (skills). Then "SALARY RANGE: $30.26- $45.40 Hourly". Then EEO boilerplate to remove.
We need to map to sections: About the role (brief description). Responsibilities (principal responsibilities + essential functions). Requirements (maybe minimum qualifications? Actually qualifications separate). Skills (special qualifications). Pay (salary range). Benefits (none given). Schedule (none given). So we include About the role, Responsibilities, Requirements (maybe education/experience), Qualifications (maybe skills?), but we need to avoid duplication. The instruction: use headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can have multiple sections. We need to decide what content goes where.
We have:
- About the role: Hybrid: Applicants must be a California resident as of their first day of employment. Also maybe brief description? Could include that.
- Responsibilities: Principal responsibilities list and essential functions.
- Requirements: Minimum years of experience, education? Actually education is qualification. But we can put education under Requirements? Usually Requirements includes education and experience. Qualifications could be skills, licenses. But we have "MINIMUM QUALIFICATIONS:" includes education, experience, special qualifications (skills). So we could split: Requirements: Education and experience. Qualifications: Skills/abilities. Or we could combine. The instruction says prefer a few substantive sections over many thin ones. So maybe we combine education, experience, skills into one "Qualifications" section. But we also have separate "Skills" heading possible. Let's think: The posting has "MINIMUM QUALIFICATIONS:" then "EDUCATION OR TRAINING EQUIVALENT TO: HS diploma or equivalent, required Associates and/or bachelor's degree, preferred." Then "MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE: Minimum of one to two year of experience in health services, managed care, hospital, or similar setting, required." Then "SPECIAL QUALIFICAITONS (SKILLS, ABILITIES, LICENSE): Knowledge of managed care and medical terminology; Experience in a customer service or coordination in a healthcare setting or equivalent experience; Excellent verbal and written communication skills; Team player who builds effective working relationships; Strong organizational skills; Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint; and Excellent verbal and written communication skills a must."
Thus we could have a section "Qualifications" containing education, experience, and skills. Or we could have "Requirements" for education/experience and "Skills" for skills. But to avoid many thin sections, maybe combine into "Qualifications". The instruction says use headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't require using all; we can choose which to include. So we can include About the role, Responsibilities, Qualifications, Pay. That's four sections. That seems sufficient.
We must not repeat job title as heading. No Job ID. Remove boilerplate.
We need to preserve all substantive information. So we need to include the hybrid California resident requirement, the responsibilities list (all bullet points), essential functions list, physical requirements? Physical requirements is substantive; should we include? It's not covered by any of the headings list except maybe we could put under Responsibilities? But it's separate. Could we add a section "Requirements" for physical requirements? But we already used Qualifications for education/experience/skills. We could add a "Requirements" section for physical requirements and maybe number of employees supervised. However the instruction says prefer a few substantive sections over many thin ones. Adding another section may be okay if it's substantive. Physical requirements is substantive. Number of employees supervised is minor metadata; could be folded into a short p or dropped. We could include physical requirements under a "Requirements" heading (maybe as part of Responsibilities? Not ideal). But we could create a "Requirements" section for physical requirements and maybe other job requirements (like California resident). However the California resident is more about eligibility; could be in About the role.
Let's think: We have headings list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We could assign:
- About the role: Hybrid California resident requirement + maybe brief description of role (the first sentence? Actually "Brief Description Hybrid: Applicants must be a California resident as of their first day of employment." That's it.)
- Responsibilities: Principal responsibilities + Essential Functions Of The Job (combined).
- Requirements: Physical Requirements + Number of Employees Supervised (maybe as short p). Also maybe "Hybrid"? But we already used that.
- Qualifications: Education, experience, special qualifications (skills). Could also include "Excellent verbal and written communication skills a must." etc.
- Pay: Salary range.
We omit Benefits and Schedule as not present.
We must not create sections with filler like "not specified". So we only include sections with real content.
Now we need to format: Use
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes: Brief Description (Hybrid: Applicants must be a California resident as of their first day of employment.) That's like About the role? Could be "About the role". Then "PRINCIPAL RESPONSIBILITIES:" with many bullet-like sentences. Then "Essential Functions Of The Job" (maybe also responsibilities). Then "Physical Requirements". Then "Number of Employees Supervised: 0". Then "MINIMUM QUALIFICATIONS:" with education, experience, special qualifications (skills). Then "SALARY RANGE: $30.26- $45.40 Hourly". Then EEO boilerplate to remove.
We need to map to sections: About the role (brief description). Responsibilities (principal responsibilities + essential functions). Requirements (maybe minimum qualifications? Actually qualifications separate). Skills (special qualifications). Pay (salary range). Benefits (none given). Schedule (none given). So we include About the role, Responsibilities, Requirements (maybe education/experience), Qualifications (maybe skills?), but we need to avoid duplication. The instruction: use headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can have multiple sections. We need to decide what content goes where.
We have:
- About the role: Hybrid: Applicants must be a California resident as of their first day of employment. Also maybe brief description? Could include that.
- Responsibilities: Principal responsibilities list and essential functions.
- Requirements: Minimum years of experience, education? Actually education is qualification. But we can put education under Requirements? Usually Requirements includes education and experience. Qualifications could be skills, licenses. But we have "MINIMUM QUALIFICATIONS:" includes education, experience, special qualifications (skills). So we could split: Requirements: Education and experience. Qualifications: Skills/abilities. Or we could combine. The instruction says prefer a few substantive sections over many thin ones. So maybe we combine education, experience, skills into one "Qualifications" section. But we also have separate "Skills" heading possible. Let's think: The posting has "MINIMUM QUALIFICATIONS:" then "EDUCATION OR TRAINING EQUIVALENT TO: HS diploma or equivalent, required Associates and/or bachelor's degree, preferred." Then "MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE: Minimum of one to two year of experience in health services, managed care, hospital, or similar setting, required." Then "SPECIAL QUALIFICAITONS (SKILLS, ABILITIES, LICENSE): Knowledge of managed care and medical terminology; Experience in a customer service or coordination in a healthcare setting or equivalent experience; Excellent verbal and written communication skills; Team player who builds effective working relationships; Strong organizational skills; Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint; and Excellent verbal and written communication skills a must."
Thus we could have a section "Qualifications" containing education, experience, and skills. Or we could have "Requirements" for education/experience and "Skills" for skills. But to avoid many thin sections, maybe combine into "Qualifications". The instruction says use headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't require using all; we can choose which to include. So we can include About the role, Responsibilities, Qualifications, Pay. That's four sections. That seems sufficient.
We must not repeat job title as heading. No Job ID. Remove boilerplate.
We need to preserve all substantive information. So we need to include the hybrid California resident requirement, the responsibilities list (all bullet points), essential functions list, physical requirements? Physical requirements is substantive; should we include? It's not covered by any of the headings list except maybe we could put under Responsibilities? But it's separate. Could we add a section "Requirements" for physical requirements? But we already used Qualifications for education/experience/skills. We could add a "Requirements" section for physical requirements and maybe number of employees supervised. However the instruction says prefer a few substantive sections over many thin ones. Adding another section may be okay if it's substantive. Physical requirements is substantive. Number of employees supervised is minor metadata; could be folded into a short p or dropped. We could include physical requirements under a "Requirements" heading (maybe as part of Responsibilities? Not ideal). But we could create a "Requirements" section for physical requirements and maybe other job requirements (like California resident). However the California resident is more about eligibility; could be in About the role.
Let's think: We have headings list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We could assign:
- About the role: Hybrid California resident requirement + maybe brief description of role (the first sentence? Actually "Brief Description Hybrid: Applicants must be a California resident as of their first day of employment." That's it.)
- Responsibilities: Principal responsibilities + Essential Functions Of The Job (combined).
- Requirements: Physical Requirements + Number of Employees Supervised (maybe as short p). Also maybe "Hybrid"? But we already used that.
- Qualifications: Education, experience, special qualifications (skills). Could also include "Excellent verbal and written communication skills a must." etc.
- Pay: Salary range.
We omit Benefits and Schedule as not present.
We must not create sections with filler like "not specified". So we only include sections with real content.
Now we need to format: Use for each section heading. Under each, use
for prose,
- for lists.
We need to preserve all substantive information: So we need to include each responsibility sentence as list items? The responsibilities are a paragraph with sentences separated by periods. We could split into list items for clarity. The instruction: Use
- for any list of duties/requirements/benefits. So we should convert the responsibilities into a list. Similarly essential functions could be list. Physical requirements could be list.
We must not invent or summarize away detail. So we need to keep the exact wording? We can keep the sentences as they appear, but we can break them into list items. Must not lose any detail.
Let's extract responsibilities text:
"PRINCIPAL RESPONSIBILITIES: Under general supervision of the Grievance and Appeals Supervisor, the Grievance and Appeals Coordinator II will review, investigate and process non-complex grievances for all lines of business and the completion of written communication documents to convey determination. The Coordinator is responsible for processing and monitoring the grievance process and corresponding documentation continuously for quality and accuracy while working independently within a team environment. Principle responsibilities include: Address and respond to telephonic and written inquiries regarding member non-complex grievances ensuring correct identification and categorization of one or more issues raised by the member, members representative or provider on behalf of member.Independently investigate, research, review, and resolve non-complex grievances within regulated timeframes, while clarifying issues and educating members in the process.Perform research and identify key policy provisions such as clinical guidelines, plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations.Interpret member contracts, internal policies, and procedures as well as regulatory and accreditation requirements.Frequently communicate with members from intake to completion of a case.Provide excellent customer service in order to gather information and communicate disposition. Generate written correspondence to members and members representative or provider on behalf of member.Interprets and explains health plan benefits, policies, procedures, and functions to members and providers both verbally and in writing, ensuring that all communication meets regulatory standards and contractual obligations.Identify system issues that result in failure to provide appropriate care to members or failure to meet service expectations.Thoroughly document the investigation and resolution of each case.Maintain an accurate and complete appeals/grievance record in the electronic database.Coordinate and prepare the Alliance component of the State Fair Hearing, MAXIMUS, Independent Medical Review (IMR), and DMHC appeal processes.Ensure compliance with state and federal regulations as they relate to appeal and grievance issues.Serve as the liaison with other departments to resolve grievance issues.Ensure timely communication with the Supervisor on all issues having potential risk and or impact on operations.Engage in special projects as assigned/requested.Other duties as assigned."
Note there are some missing spaces after periods (e.g., "member.Independently"). We'll keep as is but maybe add a space for readability? But we must not invent detail; adding a space is minor formatting, not changing content. Probably okay.
Essential Functions Of The Job:
"Essential Functions Of The Job Ability to manage a caseload of a minimum of 60 cases a month.Coordinate non-complex grievance activities by receiving, handling, and resolving member issues and operational issues with other organizational staff.Achieve compliance, quality, and production standards.Ensure all cases and correspondence are managed in accordance with accreditation, regulatory, contractual compliance, and timeliness standards.Maintain pertinent documents, case files, and correspondence in an organized, confidential, and secure manner.Perform ongoing data entry.Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls."
Again missing spaces.
Physical Requirements:
"Physical Requirements Constant and close visual work at desk or computer;Constant sitting and working at desk;Constant use of keyboard and/or mouse;Constant use of telephone headset;Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person;Frequent lifting of folders and various objects weighing between 0 and 30 lbs;Frequent walking and standing; andOccasional driving of automobiles."
Number of Employees Supervised: 0.
Now Qualifications:
"MINIMUM QUALIFICATIONS: EDUCATION OR TRAINING EQUIVALENT TO: HS diploma or equivalent, requiredAssociates and/or bachelor's degree, preferred. MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE: Minimum of one to two year of experience in health services, managed care, hospital, or similar setting, required. SPECIAL QUALIFICAITONS (SKILLS, ABILITIES, LICENSE): Knowledge of managed care and medical terminology;Experience in a customer service or coordination in a healthcare setting or equivalent experience;Excellent verbal and written communication skills;Team player who builds effective working relationships;Strong organizational skills;Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint; and Excellent verbal and written communication skills a must."
Note duplicate "Excellent verbal and written communication skills". We'll keep both? It's duplicate; we could keep one but that would be summarizing away detail? It's duplicate; removing duplicate might be considered summarizing? But it's redundant; we could keep both but it's odd. Probably we can keep one instance; but the instruction says preserve ALL substantive information; duplicate is still substantive but repeating same phrase. Removing one could be considered omitting duplicate info, but it's still substantive? Might be okay to keep one to avoid redundancy. However to be safe, we could keep both as separate list items; it's not inventing, just repeating. That's fine.
Pay: "SALARY RANGE: $30.26- $45.40 Hourly"
Now About the role: "Brief Description Hybrid: Applicants must be a California resident as of their first day of employment."
We could also include that it's hybrid? The phrase "Hybrid:" maybe indicates hybrid work arrangement. So we include that.
Now we need to output HTML fragment only.
Structure:
About the role
Hybrid: Applicants must be a California resident as of their first day of employment.
Responsibilities
- for any list of duties/requirements/benefits. So we should convert the responsibilities into a list. Similarly essential functions could be list. Physical requirements could be list.
We must not invent or summarize away detail. So we need to keep the exact wording? We can keep the sentences as they appear, but we can break them into list items. Must not lose any detail.
Let's extract responsibilities text:
"PRINCIPAL RESPONSIBILITIES: Under general supervision of the Grievance and Appeals Supervisor, the Grievance and Appeals Coordinator II will review, investigate and process non-complex grievances for all lines of business and the completion of written communication documents to convey determination. The Coordinator is responsible for processing and monitoring the grievance process and corresponding documentation continuously for quality and accuracy while working independently within a team environment. Principle responsibilities include: Address and respond to telephonic and written inquiries regarding member non-complex grievances ensuring correct identification and categorization of one or more issues raised by the member, members representative or provider on behalf of member.Independently investigate, research, review, and resolve non-complex grievances within regulated timeframes, while clarifying issues and educating members in the process.Perform research and identify key policy provisions such as clinical guidelines, plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations.Interpret member contracts, internal policies, and procedures as well as regulatory and accreditation requirements.Frequently communicate with members from intake to completion of a case.Provide excellent customer service in order to gather information and communicate disposition. Generate written correspondence to members and members representative or provider on behalf of member.Interprets and explains health plan benefits, policies, procedures, and functions to members and providers both verbally and in writing, ensuring that all communication meets regulatory standards and contractual obligations.Identify system issues that result in failure to provide appropriate care to members or failure to meet service expectations.Thoroughly document the investigation and resolution of each case.Maintain an accurate and complete appeals/grievance record in the electronic database.Coordinate and prepare the Alliance component of the State Fair Hearing, MAXIMUS, Independent Medical Review (IMR), and DMHC appeal processes.Ensure compliance with state and federal regulations as they relate to appeal and grievance issues.Serve as the liaison with other departments to resolve grievance issues.Ensure timely communication with the Supervisor on all issues having potential risk and or impact on operations.Engage in special projects as assigned/requested.Other duties as assigned."
Note there are some missing spaces after periods (e.g., "member.Independently"). We'll keep as is but maybe add a space for readability? But we must not invent detail; adding a space is minor formatting, not changing content. Probably okay.
Essential Functions Of The Job:
"Essential Functions Of The Job Ability to manage a caseload of a minimum of 60 cases a month.Coordinate non-complex grievance activities by receiving, handling, and resolving member issues and operational issues with other organizational staff.Achieve compliance, quality, and production standards.Ensure all cases and correspondence are managed in accordance with accreditation, regulatory, contractual compliance, and timeliness standards.Maintain pertinent documents, case files, and correspondence in an organized, confidential, and secure manner.Perform ongoing data entry.Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls."
Again missing spaces.
Physical Requirements:
"Physical Requirements Constant and close visual work at desk or computer;Constant sitting and working at desk;Constant use of keyboard and/or mouse;Constant use of telephone headset;Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person;Frequent lifting of folders and various objects weighing between 0 and 30 lbs;Frequent walking and standing; andOccasional driving of automobiles."
Number of Employees Supervised: 0.
Now Qualifications:
"MINIMUM QUALIFICATIONS: EDUCATION OR TRAINING EQUIVALENT TO: HS diploma or equivalent, requiredAssociates and/or bachelor's degree, preferred. MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE: Minimum of one to two year of experience in health services, managed care, hospital, or similar setting, required. SPECIAL QUALIFICAITONS (SKILLS, ABILITIES, LICENSE): Knowledge of managed care and medical terminology;Experience in a customer service or coordination in a healthcare setting or equivalent experience;Excellent verbal and written communication skills;Team player who builds effective working relationships;Strong organizational skills;Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint; and Excellent verbal and written communication skills a must."
Note duplicate "Excellent verbal and written communication skills". We'll keep both? It's duplicate; we could keep one but that would be summarizing away detail? It's duplicate; removing duplicate might be considered summarizing? But it's redundant; we could keep both but it's odd. Probably we can keep one instance; but the instruction says preserve ALL substantive information; duplicate is still substantive but repeating same phrase. Removing one could be considered omitting duplicate info, but it's still substantive? Might be okay to keep one to avoid redundancy. However to be safe, we could keep both as separate list items; it's not inventing, just repeating. That's fine.
Pay: "SALARY RANGE: $30.26- $45.40 Hourly"
Now About the role: "Brief Description Hybrid: Applicants must be a California resident as of their first day of employment."
We could also include that it's hybrid? The phrase "Hybrid:" maybe indicates hybrid work arrangement. So we include that.
Now we need to output HTML fragment only.
Structure: