Thank you for considering a career at Mercy Health!

Scheduled Weekly Hours:

Work Shift:

Summary of Primary Function 

 The CMS Grievance Coordinator is responsible for the day-to-day work with the tracking and case management of patient-related concerns, grievances, complaints and appeals received for assigned client hospital(s).   This position will receive, respond and log grievances while providing investigational support and follow-up as necessary as part of the hospital response and/or appeal to a patient grievance pursuant to CMS guidelines and/or managed care requirements including state regulation(s).  This position must function in collaboration with clinical quality, hospital operational leadership and the risk department. (CMS Conditions of Participation are the guidelines that hospitals must follow to receive Medicare funding.)

Essential Job Functions

• Will appropriately acknowledge the receipt of all concerns, grievance/appeals and track utilizing the case management workflow methodology instructed from the BSMH Quality department.
• Responsible for the gathering of all pertinent and relevant information from the patient and/or family member regarding the grievance/appeal, determining the appropriate resolution of the grievance/appeal per standard policies and procedures; and notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue(s).
• Provides investigation and follow-up related to patient grievance(s) ensuring appropriate resolution in writing as required by hospital policy and CMS Conditions of Participation.
• Collects, analyzes, and reports data through the quality reporting structure of the organization to the facility Grievance Committee and other leaders as determined by policy and/or facility leadership. Assists in preparation of annual report of the grievance/resolution process to Board of Trustees.
• Collaborates with quality, risk, and leadership team to investigate and ensure appropriate follow-up of grievance. Communicates effectively with patient, family, and hospitals leaders.
• Utilizes appropriate databases for data entry and issue tracking.  Maintains accurate and timely documentation, including complete database, issue tracking and files of all concerns, grievances/appeals.
• Develops excellent relationships with department leaders, medical staff and others to fully investigate and resolve issues.
• Possesses excellent letter writing and computer skills with knowledge of Word, Excel and Power Point and a willingness to work within the electronic medical record as necessary.
• Able to represent the hospital in meetings and presentations to patient families and medical staff in relation to the grievance process. Demonstrates ability to identify and define problems, collect data/information, establish facts and draw valid conclusions with critical thinking skills. 
• May be asked to be part of the Incident Command Center during a crisis by assisting the Family Information Center.
• Must possess a high degree of professionalism and able to set goals, prioritize and achieve results in accordance with the highest standards and applies procedures to reflect hospital and professional practice standards interpretation with clinical leaders for handling complaints and grievances.

Employment Qualifications

Required Minimum Education:

2 Year/ Associates Degree

Specialty/Major:

Business or Healthcare Services

Preferred Education:

4 year/ Bachelors Degree

Specialty/Major:

Healthcare Administration or Business Management

Minimum Years and Type of Experience:

1 - 3 years healthcare experience and demonstrated customer service skills; familiarity with CMS and other managed care insurance management programs or complaint/investigation department.

Other Knowledge, Skills and Abilities Required:

Excellent communication skills; with ability to collaborate and communicate sensitively and respectfully.  Demonstrate professionalism and leadership.

Other Knowledge, Skills and Abilities Preferred:

Ability to organize and prioritize

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Mercy Health is an equal opportunity employer.

As a Mercy Health associate, you’re part of a Misson that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way. 

What we offer
•    Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
•    Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts
•    Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
•    Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.
 

Department:

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected].