About The Position
This position manages project activities and participates in the development and monitoring of all related tasks. The role involves managing medical and non-medical appeals decisions. The application process requires completeness, including education, employment history, and other applicable sections, as initial screening is based on minimum requirements such as education, experience, licenses, and certifications. Experience should also address the knowledge, skills, and abilities needed for the role. Incomplete applications will not be considered.
Requirements
- Associate’s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
- Five (5) years conducting or overseeing Medicare appeals, medical review, or utilization management of Medicare claims.
- Three (3) years management or supervisory Healthcare Professional with one (1) year demonstrated experience writing, making, or overseeing Medicare related medical necessity decisions
- Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
Nice To Haves
- Additional clinical or medical administration experience may be substituted for Associate’s degree on a year per year basis.
- Conducting or overseeing Medicare Part C related appeals activities
Responsibilities
- Plans and manages project activities to meet contract deliverables.
- Plans, manages, and develops a standardized approach for dissemination and communication of project information.
- Plans, manages, and develops presentations or instructional materials related to area of responsibility.
- Plans, prepares, and facilitates regular team meetings.
- Manages, trains, and evaluates project work activities and personnel.
- Manages the administrative processing of appeals/disputes and the coordination of workflow among internal staff and subcontractors.
- Manages, establishes, and maintains professional and effective working relationships with external business partners and internal staff.
Benefits
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Competitive salary
- License/credentials reimbursement
- Tuition Reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Associate degree
