Program Assistant (GARS)

Johnson Service Group

Orange, CA
3 days ago

$24 Per Hour

Highlights

Monitors inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS). Coordinates administrative support for state hearings, serves as a contact with DSS for incoming cases, enters cases in the GARS system, creates electronic files and routes the scanned documents to designated staff and fax required state hearing documentation to the local hearing office as necessary.

Numbers & Facts

Location	Orange, CA
Industry	Staffing/Employment Agencies
Salary	$24 Per Hour
Company Size	1,000 to 1,499 employees
Year Founded	1984
Website	https://www.jsginc.com/

Description

Johnson Service Group (JSG) is seeking a Customer Service/ Claims Assistant at a Health Plan Partner. This position is on-site in Orange County, CA.
Work Schedule: Mon-Friday 8am-4pm
Pay Range: $24-$33.50 per hour
Duties & Responsibilities:

80% - Program Support
- 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 the point of contact within or outside Company 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 inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS).
- Responds to DMHC requests for information in a timely manner.
- Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns them to appropriate staff.
15% - Administrative Support
- Works with internal and external departments and providers in gathering supporting information relevant to the case.
- Generates acknowledgment letters for all lines of business per department and regulatory standards.
- Assists in the development of departmental forms and intake processes.
- Coordinates administrative support for state hearings, serves as a contact with DSS for incoming cases, enters cases in the GARS system, creates electronic files and routes the scanned documents to designated staff and fax required state hearing documentation to the local hearing office as necessary.
5% - Other
- Completes other projects and duties as assigned.

Minimum Qualifications:

High school diploma or equivalent required PLUS 1 year of experience in appeal and grievance guidelines, Medi-Cal/Medicaid or Medicare programs required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

Bilingual in English and in one of Company defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.

About Company

At JSG, We Understand People

It is our mission to empower people, help our clients reach their goals, and hire motivated individuals.

Since our start in 1984, we’ve worked hard to establish our present position as the most effective cross-industry staffing and consulting solution available.

Headquartered in Chicago, IL with local offices throughout the United States and Canada, JSG proudly serves a diverse range of industries with the right solutions to help clients reach their company goals. Our client-centric approach enables us to create personalized solutions for businesses in need of top-tier talent. Our dedication doesn’t stop at our clients. We strive to connect candidates with opportunities that match their skills and goals. More than just a go-between, we are a dependable bridge, uniting top talent with suitable opportunities, facilitating shared opportunities and growth.