Supervisor, Appeals and Grievances for Medicaid- Remote in Virginia

Sentara Health

4d•Remote

About The Position

Assumes responsibility, accountability and leadership for the daily operations. First line supervisor in the Department responsible for quality and service. Facilitates the work of assigned team members. Responsible for leading the Appeals efforts, providing oversight, training and guidance to the team. Conducting in-depth investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances. Provide training and/or presentations to staff, external brokers and providers. Knowledgeable of full range of products at Sentara Health Plans. Manage a team of up to 10 Appeals and Grievances Coordinator

Requirements

Bachelor’s Level Degree OR 5 or more years of Medicare appeals at a health plan REQUIRED
Managed Care- 5 years of experience REQUIRED
Healthcare Complaints/Appeals- 3 years of experience REQUIRED

Nice To Haves

Previous member appeals and grievances in Medicaid experience preferred
Medicare experience is acceptable
Supervisory experience preferred

Responsibilities

Assumes responsibility, accountability and leadership for the daily operations.
First line supervisor in the Department responsible for quality and service.
Facilitates the work of assigned team members.
Responsible for leading the Appeals efforts, providing oversight, training and guidance to the team.
Conducting in-depth investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements.
Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.
Provide training and/or presentations to staff, external brokers and providers.
Knowledgeable of full range of products at Sentara Health Plans.
Manage a team of up to 10 Appeals and Grievances Coordinator

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.