QM Coordinator

Job description

Overview The Grievance Coordinator is responsible for assisting with preparing dental records (charts and x-rays), opening new grievances, working with payer and dental board complaints. This position ensures that all grievances and appeals are processed timely and data entered accurately. The QM Coordinator plays a key role in maintaining member satisfaction, regulatory compliance, and quality improvement. Responsibilities: - Receive, document, and acknowledge grievances and appeals within required timeframes. - Investigate complaints, including research with dental offices, involving dental benefits, claims processing, provider services, and quality of care issues. - Prepare dental records, which include patient/office history and dental ledgers, and clinical documentation. - Collaborate with internal teams such as the Grievance Coordinator or Sr. Manager of QM to ensure proper hand-off of grievances for resolution. - Respond, where needed, accurately and with proper grammar to various entities submitting complaints. - Track and monitor open cases to ensure compliance with regulatory deadlines (e.g., state Department of Insurance, CMS, payer guidelines, and NCQA standards). - Mai...