Appeals Specialist - Temporary
About The Position
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Appeals Specialist to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Position Summary: Responsible for assisting with coordination of all appeal/grievance activity for the Plan. Responsible for ensuring departmental compliance with applicable regulations and tracking appeal and grievance activity, complying with state and regulatory standards. Assists in preparing and researching case files as necessary. Responsible for research and resolution of member and provider claims issues. Responsible for assisting with member and provider education opportunities regarding complaints/grievances/appeals. Identifies process improvement opportunities and develops plans to address opportunities. This is a hybrid position with requirements to come on site as scheduled, Flint, MI.
Requirements
- High School Diploma or equivalent (GED).
- One (1) year experience in healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.
Nice To Haves
- Associate degree in business, health care or related field.
- Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, regulatory compliance, claims processing, membership/eligibility).
- Two (2) years' healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.
Responsibilities
- Responsible for assisting with coordination of all appeal/grievance activity for the Plan.
- Responsible for ensuring departmental compliance with applicable regulations and tracking appeal and grievance activity, complying with state and regulatory standards.
- Assists in preparing and researching case files as necessary.
- Responsible for research and resolution of member and provider claims issues.
- Responsible for assisting with member and provider education opportunities regarding complaints/grievances/appeals.
- Identifies process improvement opportunities and develops plans to address opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
