Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing
Perform duties as the point of contact with the State
Manage the day to day responsibilities of the Grievance & Appeals Coordinators
Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements
Monitor appeals and grievances and provide senior management with monthly reporting on trends
Ensure that all members and provider grievances are processed and investigated according to contract requirements
Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals
Integrate federal and state law changes into company’s regulatory system related to grievance and appeals
Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements
Review and process incoming incident/accident reports
Requirements
Bachelor’s degree in related field or equivalent experience
3+ plus years of experience in healthcare/law, grievances and appeals
Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff
Benefits
competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules
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