Grievance Coordinator at Akido — Ontario, United States

About The Role

&lt;div class=&quot;content-intro&quot;&gt;&lt;p&gt;Akido builds AI-powered doctors&lt;strong&gt;.&lt;/strong&gt; Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America’s physician shortage and make exceptional healthcare universal. Its AI empowers doctors to deliver faster, more accurate, and more compassionate care.&lt;/p&gt;
&lt;p&gt;Serving 500K+ patients across California, Rhode Island, and New York, Akido offers primary and specialty care in 26 specialties—from serving&amp;nbsp;&lt;a href=&quot;https://www.fastcompany.com/91231274/how-one-la-doctor-is-using-ai-to-help-homeless-communities-get-medical-care&quot;&gt;unhoused communities&lt;/a&gt;&amp;nbsp;in Los Angeles to&amp;nbsp;&lt;a href=&quot;https://www.wsj.com/articles/the-ai-doctor-will-see-new-york-ride-share-drivers-now-5ba53e6c?mod=Searchresults_pos1&amp;amp;page=1&quot;&gt;ride-share drivers&lt;/a&gt;&amp;nbsp;in New York.&lt;/p&gt;
&lt;p&gt;Founded in 2015 (YC W15), Akido is expanding its risk-bearing care models and scaling&amp;nbsp;ScopeAI, its breakthrough clinical AI platform. &lt;a href=&quot;https://www.businesswire.com/news/home/20250515102298/en/Akido-Raises-%2460-Million-Series-B-to-Expand-Reach-of-ScopeAI-its-Breakthrough-Health-Artificial-Intelligence&quot;&gt;Read more about Akido’s $60M Series B&lt;/a&gt;. More info at &lt;a href=&quot;http://Akidolabs.com&quot;&gt;Akidolabs.com&lt;/a&gt;.&lt;/p&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Position Summary&lt;/span&gt;&lt;/strong&gt;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;span data-contrast=&quot;auto&quot;&gt;The Grievance Coordinator is responsible for the management, investigation, documentation, and resolution of all health plan grievances, complaints, appeals support, and regulatory inquiries for clinics across the region. This role serves as the central point of contact for health plan grievance communications and ensures timely, accurate, and compliant responses in accordance with federal, state, health plan, and organizational requirements.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span data-contrast=&quot;auto&quot;&gt;The Grievance Coordinator partners closely with clinic leadership, providers, operations teams, patient relations, quality, compliance, and health plans to investigate concerns, gather supporting documentation, identify root causes, and prepare comprehensive grievance responses. The position plays a critical role in maintaining regulatory compliance, improving patient satisfaction, identifying operational opportunities for improvement, and strengthening relationships with health plan partners.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span data-contrast=&quot;auto&quot;&gt;The ideal candidate possesses strong investigative skills, exceptional written communication abilities, healthcare operations knowledge, and the ability to manage multiple deadlines in a fast-paced environment.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Essential Functions&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Serve as the primary coordinator for all health plan grievances, complaints, and member concerns received across the region. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Receive, review, investigate, and respond to grievances within required regulatory and contractual timelines.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Collaborate with clinic leaders, providers, departments, and operational teams to gather information needed for grievance investigations.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Prepare clear, accurate, and professional written responses to health plans regarding member complaints and grievances.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Review medical records, documentation, policies, procedures, and operational processes to support investigations.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ensure grievance responses meet health plan, CMS, state, delegated entity, and organizational requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain detailed records of grievance investigations, findings, corrective actions, and resolutions.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Monitor grievance deadlines and ensure timely submission of responses and supporting documentation.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Identify trends, recurring issues, and operational concerns through grievance analysis.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Escalate high-risk, regulatory, compliance, or quality concerns to leadership as appropriate.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Coordinate with Patient Relations, Quality, Compliance, and Clinical Operations teams to implement corrective actions.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Participate in audits and prepare documentation for health plan reviews and regulatory requests. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain confidentiality and compliance with HIPAA and privacy regulations.&lt;/span&gt; &amp;nbsp;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Key Responsibilities&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Manage the grievance process from receipt through resolution for all assigned health plans and clinics. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Track and prioritize multiple grievance cases while ensuring compliance with turnaround time requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Draft professional grievance response letters and health plan communications.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Conduct routine follow-up with clinic leadership and stakeholders regarding open grievance investigations.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain grievance logs, databases, reporting tools, and supporting documentation.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ensure complete, accurate, and timely documentation of all grievance activities.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Analyze grievance trends and identify opportunities for process improvement and member satisfaction enhancements. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Assist leadership in developing corrective action plans related to grievance findings.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Prepare recurring reports and dashboards related to grievance volume, timeliness, outcomes, and trends.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Participate in health plan meetings and delegated oversight activities as assigned.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Provide education and guidance to clinic staff regarding grievance management processes and best practices.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Support patient experience initiatives by identifying barriers impacting member satisfaction.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Collaborate with operational and clinical leaders to address systemic issues contributing to grievances.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Maintain current knowledge of health plan requirements, regulatory updates, and industry best practices.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Required Qualifications&lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;High School Diploma or equivalent required. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Minimum of one (1) year of healthcare operations, patient relations, grievance management, quality, compliance, or health plan experience.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience investigating and responding to patient complaints, grievances, or regulatory inquiries.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Knowledge of managed care, healthcare operations, regulatory compliance, and health plan requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Strong written communication skills with the ability to draft professional and detailed correspondence.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Excellent organizational and time management skills.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ability to manage multiple projects and deadlines simultaneously.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Proficiency with electronic health records (EHR), Microsoft Office Suite, and reporting systems.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Strong analytical, problem-solving, and investigative skills.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ability to maintain confidentiality and exercise sound judgment when handling sensitive information.&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Preferred Qualifications&lt;/span&gt;&lt;/strong&gt;&amp;nbsp;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience working with Medicare, Medicaid, Commercial Health Plans, or Delegated Medical Groups. &lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Prior experience in grievance and appeals management.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Knowledge of CMS, DHCS, NCQA, and health plan grievance requirements.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience with quality improvement and performance improvement initiatives.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Experience preparing regulatory responses and corrective action plans.&amp;nbsp;&lt;/span&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;strong&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Physical Requirements:&lt;/span&gt;&lt;/strong&gt;&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;&lt;span data-contrast=&quot;auto&quot;&gt;Ability to sit and/or stand for prolonged periods of time.&lt;/span&gt; &lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Ability to move/carry objects up to 20 pounds. &lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Moving from one work site to another as needed. &lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Ability to communicate with others to exchange information &lt;/li&gt;
&lt;li data-leveltext=&quot;&quot; data-font=&quot;Symbol&quot; data-listid=&quot;1&quot; data-list-defn-props=&quot;{&amp;quot;335552541&amp;quot;:1,&amp;quot;335559685&amp;quot;:720,&amp;quot;335559991&amp;quot;:360,&amp;quot;469769226&amp;quot;:&amp;quot;Symbol&amp;quot;,&amp;quot;469769242&amp;quot;:[8226],&amp;quot;469777803&amp;quot;:&amp;quot;left&amp;quot;,&amp;quot;469777804&amp;quot;:&amp;quot;&amp;quot;,&amp;quot;469777815&amp;quot;:&amp;quot;hybridMultilevel&amp;quot;}&quot; data-aria-posinset=&quot;1&quot; data-aria-level=&quot;1&quot;&gt;Ability to use and/or type on a laptop/keyboard.&lt;span data-ccp-props=&quot;{}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;&lt;div class=&quot;content-pay-transparency&quot;&gt;&lt;div class=&quot;pay-input&quot;&gt;&lt;div class=&quot;title&quot;&gt;Hourly pay range&lt;/div&gt;&lt;div class=&quot;pay-range&quot;&gt;&lt;span&gt;$28&lt;/span&gt;&lt;span class=&quot;divider&quot;&gt;&amp;mdash;&lt;/span&gt;&lt;span&gt;$34 USD&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;div class=&quot;content-conclusion&quot;&gt;&lt;p data-pm-slice=&quot;1 1 []&quot;&gt;Akido Labs, Inc. is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.&lt;/p&gt;&lt;/div&gt;