Another Day Another Dollar

This is my first post for National Blog Posting Month (NaBloPoMo). My goal is to update my blog once a day for the month of December.  It will be a challenge because I have not been able to update this particular blog since its inception. I figure that if I have free time at work I would be able update once a day.

I am currently sitting in my cubicle without much to do. I have caught up on all my work, so now I get to sit around and wait for more work to come my way. So what exactly is it that I do?  I am an Appeals and Grievances Coordinator for a national Medicare Advantage Private-Fee-for-Service Insurance Company.

My job, or what I do on a daily basis, is research and resolve grievances sent to us by our enrollees or members.  I have had this position since the end of August. In the beginning I enjoyed learning the daily process, and then I went through a phase of not enjoying my job.  Now I don’t particularly enjoy my job, but I have a better understanding of what is expected of me which makes my job easier.  It is a big improvement than my former position of working in the Customer Service call center. I am grateful for my job; I am glad I can pay my bills and put food in my stomach.

Here is a brief breakdown of what I do everyday, minus the info about clock in, taking breaks and lunch. My company is a Medicare Advantage company therefore we are required to follow Medicare guidelines set forth in the Medicare Managed Care Manual.  My department is particularly interested in Chapter 13 and Chapter 8. When an enrollee sends us correspondence regarding any issue it is forwarded to our department to determine if it is a grievance, an appeal or an inquiry for another department. I handle grievances only.

I will be given a case file of the correspondence. I read it over to determine if it fits Medicare’s definition of a grievance. If it is a grievance I then classify the grievance according to type. Basically I am determining of they are upset about their benefits, their agent, their premiums, so on and so forth. Once the classification is done I have to send the enrollee an acknowledgement letter. The letter has to be sent within 14 days of receiving the correspondence. The entire case has to be resolved within 30 days of receiving the correspondence.

Once the acknowledgement letter is sent out I begin researching the issue.  Many times I have to obtain information from another department such as Accounting or Benefits. Other times I need to contact providers to ask them about how they submitted a claim or if I could get a corrected claim submitted to me directly.

The final step is writing a resolution letter. Many of our cases are similar so we have developed basic templates that can be modified to fit the exact issue. Once the resolution letter has been approved I close out the case in our database. 

I was informed moments ago that because I have no open cases I will be assigned other people’s cases. That doesn’t seem fair I worked hard to resolve my cases and because I am trying to make sure my Christmas and New Years weeks aren’t busy. I won’t be able to try and get a day off between now and the end of the year.


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