GARS Program Assistant - Continuous Learning Opportunities

Title: Program Assistant - GARS

Duration: Temp – Contract

Compensation: $20.81 - $29.71 per hour

Description: 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.

What You Will Do:

• 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 the organization 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 acknowledgement 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.

You Will Be Successful If:

• 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 the Health Plan's 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

What You Will Bring:

• High school diploma or equivalent
• 1+ year of experience in appeal and grievance guidelines or Medi-Cal or Medicare programs
• 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.
• Bilingual in English and one of the following languages preferred: Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!