Supervisor, Appeals - Health Care - Remote CONUS

Job Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

Required

Minimum of 5 years in health care appeals, compliance and/or grievances/complaints in a quality improvement environment.

Strong verbal and written communication skills.

Working knowledge of Microsoft Office Product Suite.

This position provides supervision and monitoring of unlicensed Appeals and/or Grievance Coordinators responsible for all appeal, scheduling, provider dispute activities and/or grievance/complaint handling, including staff adherence to departmental performance standards.

Monitors and manages initial escalated issues related to daily non-authorization, appeals, provider dispute reports and/or grievances/complaints.

Manages staff by monitoring staff production and adherence to departmental standards and expectations.

Facilitates the timeliness and accuracy standards adhering to client, state and federal requirements.

Organizes volume of work and manages work assignments of staff.

Assists with providing employee training on different specialized task processes.

Assists in the development of department workflows and implementations.

Consults with clinical and/or claims staff on problem cases and interfaces with all departmental staff in resolving denial, appeal, provider dispute issues and/or grievances/complaints.

Assists in the data gathering and analysis of reports regarding appeal and provider dispute activity, as well as preparation for audits.

Capable of completing non-authorization letters and processing appeals and/or grievances/complaints as needed.

Assists schedulers in coordinating peer to peer reviews between our Physician Advisor and the requesting provider.

Maintains knowledge of the provider dispute process, if applicable, and assists as needed.

Other duties as assigned.

Auto req ID

425539BR

Minimum Education Required

Certifications/Security Clearances/Other (Enter Below)

Job_Category

Health/Medical other

Additional Qualifications/Responsibilities

Minimum of 5 years in health care appeals, compliance and/or grievances/complaints in a quality improvement environment.

Strong verbal and written communication skills.

Working knowledge of Microsoft Office Product Suite.

General Job Information

Title

Supervisor, Appeals

Grade

23

Work Experience - Required

Appeals, Compliance, Healthcare, Quality

Work Experience - Preferred

Education - Required

Education - Preferred

Bachelor's

License and Certifications - Required

License And Certifications - Preferred

Salary Range

Salary Minimum

$53,125

Salary Maximum

$84,995

City*

United States

State*

N/A

Job Code

Clinic Medical

Affiliate Sponsor

Magellan Federal - AFSC