Supervisor, Appeals and Grievances Job at Kelsey-Seybold
Overview:
Why Kelsey-Seybold Clinic?
Responsibilities:
Qualifications:
Education
Preferred: Some college of technical school
Experience
Required: 3-5 years’ experience with Appeals and Grievances or in a MA Healthcare Environment, Minimum of 3 years experience.as a supervisor/team lead or demonstrated proficiency as an Enrollment Specialist or Subject Matter Expert
Preferred: Minimum 3 years exp ASO Commercial Products/Managed Care, Experience with EPIC CRM, Experience CMS MARx system, 1 Year Quality Assurance experience
Special Skills
Required: Ability to read and interpret technical reports, Ability to understand databases including importing and exporting of data, Proficient with various applications to include: Excel, Access, Word, Visio, Ability to communicate technical concepts to technical and non-technical people.
Other
Working Environment: Office
About Us
Start your career journey and become a part of a community of renowned Healthcare professionals.
Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance
Responsibilities:
This position is responsible for supervising appeal and grievance coordinators for our Medicare Advantage plan. The supervisor manages and monitors daily assignments, productivity, processes appeals and grievance cases, and reviews appeals and grievance reports to ensure resolution of cases is done accurately and within CMS guidelines. The supervisor ensures daily, weekly, and monthly processing timelines are met and are performed accurately according to CMS guidelines for the Medicare Advantage plan which includes reviewing incoming cases from call center, incoming faxes, and mail to ensure cases are assigned. The Supervisor also maintains the internal contact list ensures complaints received from CMS are timely and complete.
This position also assists with the oversight of the Appeals and Grievance team, serves as a key liaison between the appeals and grievance staff and management staff in maintaining system analysis as it relates to the integrity of the systems, department, and process training in a state of currency.
Aids in the discovery, recommendation, and implementation of new processes based on work patterns and quality assurance results for the department and recommends workflow changes for optimum productivity. Assist with oversight of projects and serves as backup to Manager.
Qualifications:
This position also assists with the oversight of the Appeals and Grievance team, serves as a key liaison between the appeals and grievance staff and management staff in maintaining system analysis as it relates to the integrity of the systems, department, and process training in a state of currency.
Aids in the discovery, recommendation, and implementation of new processes based on work patterns and quality assurance results for the department and recommends workflow changes for optimum productivity. Assist with oversight of projects and serves as backup to Manager.
Supervisor, Appeals and Grievances
Location: Pearland Administrative Office
Location: Pearland Administrative Office
Department: KelseyCare Advantage Operations
Job Type: Full Time
Salary Range: $78,748.80 to $71,593.60
(Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Qualifications:
Education
Required: High School Diploma or equivalent
Preferred: Some college of technical school
Experience
Required: 3-5 years’ experience with Appeals and Grievances or in a MA Healthcare Environment, Minimum of 3 years experience.as a supervisor/team lead or demonstrated proficiency as an Enrollment Specialist or Subject Matter Expert
Preferred: Minimum 3 years exp ASO Commercial Products/Managed Care, Experience with EPIC CRM, Experience CMS MARx system, 1 Year Quality Assurance experience
Special Skills
Required: Ability to read and interpret technical reports, Ability to understand databases including importing and exporting of data, Proficient with various applications to include: Excel, Access, Word, Visio, Ability to communicate technical concepts to technical and non-technical people.
Other
Required: Excellent Written and Verbal Communication Skills
Detail oriented, and work with minimum supervision to meet strict regulatory guidelines.
Strong organizational skills and ability to follow through with multiple tasks
Detail oriented, and work with minimum supervision to meet strict regulatory guidelines.
Strong organizational skills and ability to follow through with multiple tasks
Working Environment: Office
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