Supervisor of Appeals & Grievances
About The Position
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.
Requirements
- BA/BS degree in Health/Human Services, Health Administration, Business Administration or related discipline is required. An associates degree will be considered with prior experience.
- 4-5 years prior related experience is required, preferably in Managed Care or Health Care related organizations.
- Minimum 1-3 years experience with appeals and grievances.
- Computer literacy including Microsoft Word, Excel, Powerpoint, capacity to learn other programs as assigned.
- Excellent written and oral communication skills.
- Good analytical abilities.
- Ability to be empathetic and understanding.
- Ability to handle confidential aspects of the position.
- Good customer service skills.
- Ability to set priorities.
- Ability to work independently while recognizing issues having a departmental or organizational impact.
Responsibilities
- Provide daily oversight and monitoring of staff intaking and assigning all appeals and grievances for all product lines and ensuring compliance with internal policies/process state and federal regulatory requirements.
- Oversee and monitor appeals and grievances received through delegated vendors, including auditing the delegated vendors processes to ensure regulatory compliance.
- Maintain and ensure integrity of case file, documentation accuracy, and data collection systems.
- Prepare data reports and analysis of grievance and appeals for program management and committees, as needed.
- Maintain current knowledge of state/federal regulatory requirements for each program.
- Identify and recommend areas for staff education and develop and implement training programs.
- Works under general direction.
Benefits
- Tuition Reimbursement for all full and part-time staff
- Generous paid time off, including your birthday!
- Affordable and comprehensive medical, dental and vision coverage for employee and family members
- Two retirement plans! 403(b) AND Employer Paid Pension
- Flexible spending
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
