Member Grievance & Appeals Clerk - Roseville, CA
Roseville, CA, US • Posted 60+ days ago • Updated 18 hours ago

Gainwell Technologies LLC
Dice Job Match Score™
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Job Details
Skills
- Management
- HIPAA
- Customer Relationship Management (CRM)
- Uploading
- Communication
- Typing
- Organizational Skills
- Problem Solving
- Conflict Resolution
- Mathematics
- Microsoft Word
- Continuous Delivery
- MMIS
- Microsoft Excel
- Expect
- SAP BASIS
- Content Management
- Change Management
- Configuration Management
- Leadership
- Health Care
- Collaboration
- Innovation
Summary
Summary
At Gainwell you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges. Here are the details on this position. .
Your role in our mission
- Retrieves new appeals information from the Appeals Case Management System (ACMS), researches denial, saves all pertinent documents and enters into the State Hearing System (SHS) and the Customer Relationship Management System (CRM) using ACMS, MEDS, CD-MMIS, and EIMS
- Mails Conditional Withdrawal letters, radiograph requests, EPSDT requests and Position Statements, reviewing all for HIPAA accuracy and uploads Position Statements, Conditional Withdrawals, and additional information to ACMS.
- Monitors CRM's State Hearing and State Hearing email queues. Closes completed cases and forwards cases from email queue that require follow-up by analyst.
- Updates the SHS and/or CRM system with hearing schedules, pre-hearing contacts, additional information received, Open Record letters and decisions.
- Scanning and uploading incoming documents and creating tasks in ACMS for case completion
What we're looking for
- Strong Communication (oral and written).
- Strong typing and word-processing skills are a must.
- Excellent organizational skills needed. Problem-solving, basic math, and computer skills needed.
- Ability to navigate through several work systems simultaneously desired. Microsoft Word, CD-MMIS, MEDS, and Excel experienced preferred.
- Medi-Cal Dental or dental office experience preferred.
What you should expect in this role
- Must be a resident of the Greater Sacramento area of California
- This posting is intended for pipelining. We will accept applications on an ongoing basis.
#LI-ONSITE
#LI-CM1
The pay range for this position is $37,500.00 - $53,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
- Dice Id: 91124603
- Position Id: 1313290500
- Posted 30+ days ago
Company Info
Gainwell is more than the technology we develop and the services we provide. Our mission-driven culture fuels everything we do, and our strength lies in the unique contributions of our team members. By fostering an environment where every idea is heard and valued, we create stronger solutions, richer collaborations, and a workplace where innovation thrives. This commitment empowers us to deliver high-quality, client-focused solutions that drive meaningful impact in healthcare.
A Workplace Built on Strengths.
Gainwell actively cultivates a culture where employees feel supported and encouraged to contribute their best. Our employees take pride in their work, knowing that their contributions directly impact the success of our clients and the communities we serve.
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