Grievance/Compliance Coordinator

Coordinates the provider grievance process by receiving and processing grievances to include the following tasks:

Research grievance issues: contact and interview appropriate subject matter expert; collect all available data regarding the grievance; ask pertinent questions; recognize trends or shortcomings.

Write letters: use the information gathered through the research process; Cite appropriate Statute or Code for decision.

Represent HCA at hearings: prepare the case, witnesses and presentation; present the case at hearing by offering an opening statement, argument and closing statement. Draft Post Hearing Memoranda and requests for rehearing as needed.

Fraud and Abuse: Works with Compliance Manager on Fraud and Abuse projects, report Fraud and Abuse to AHCCCS.
REQUIREMENTS
Associate’s degree (A.A.) or equivalent obtained at a two-year college or technical school in Healthcare, Communications or related field.

2+ years of claims/billing or applicable health care experience required.

Experience with MS ACCESS Database computer software preferred.

Excellent oral and written communication skills.

Knowledge of AHCCCS program desirable.
Knowledge of MS Windows environment.