239 Briercliff Road
Staten Island, NY 10314
Job Objective To obtain a Grievance Coordinator position that fully utilizes my experience and abilities.
Grievance Coordinator, May 2004 – Present
Fox, Staten Island, NY
- Supported Risk Management functions by conducting referral investigations, researching grievance requests, and trending events.
- Provided prompt, accurate, detailed responses of resolutions in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines.
- Ensured accurate and timely completion of each case.
- Provided timely status updates concerning requests.
- Provided trend data and other reports to the Performance Improvement Council.
- Collaborated with hospital leadership for investment implementation through timely resolution and process improvement methods.
Grievance Coordinator, March 2002 – April 2004
Intel,inc., Staten Island, NY
- Monitored grievance process to ensure compliance with federal and state regulations.
- Made recommendations on process and policy modifications and improvements.
- Compiled information and data from, analyzed information, prepared written summaries, and made recommendations.
- Served as the primary resource and point of escalation for the Grievance Coordinator.
- Assisted in training and educating Alliance staff on the grievance process.
- Developed and maintained Grievance and Member Services Department policies, procedures and processes, and compliance assessments.
Summary of Qualifications:
- Extensive customer service experience in health insurance environment
- Excellent knowledge CMS, joint commission regulations and grievances
- Sound knowledge of Medicaid Managed Care laws, regulations and benefits
- Ability to document oral information received into accurate and concise written narratives
- Profound knowledge of hospital operating systems
- Proficient with PC and MS word and excel
- Excellent organization and follow through skills
- Strong critical thinking, object problem solving and prioritization skills
- Outstanding time management skills
- Remarkable ability to meet deadlines
Bachelor of Science in Nursing, Cardinal Stritch University, Wisconsin, WI