Appeals Analyst Supervisor - Priority Health

Job Summary

Priority Health is seeking an Appeals Analyst Supervisor. The Appeals Analyst Supervisor is responsible for managing supporting and oversight of the Appeals and Grievance team. This includes analyzing evaluating and implementing corrective measures to improve performance and ensure compliance with laws regulations and other accreditation requirements as well as executing upon the operational and strategic plans to achieve expected performance. The Appeals Analyst Supervisor provides leadership to direct reports and lead process improvement initiatives. Developing action plans & performance goals identifying coaching and development needs and providing guidance and support to ensure that the goals and standards of the department are being met are key responsibilities.

Essential Functions

• Ensure that the Appeals & Grievance department processes all appeals grievances and complaints in accordance with standards and the organizations policies and procedures. Works with all key departments and external partners to ensure all are up to date with regulatory departmental and organizational changes impacting the appeals and grievances processes.

• Supervise the daytoday operations of the Appeals and Grievance staff and functions within the department ensuring productivity and quality metrics are met. Monitor and distribute teams caseload and ensure adequate coverage including after hours and weekend coverage/on call coverage.

• Lead and manage team members with onboarding training mentoring and work assignments. Support staff development through goal setting training communication accountability etc.

• Develops implements maintains and reviews the adequacy of appeal and grievance systems reporting policies and functions to achieve stated goals including but not limited to case resolution and timely responsiveness and applicable accreditation standards to ensure compliance with all relevant regulatory requirements.

• Ensure timely and effective data collection summarization integration and reporting including but not limited to productivity status and trend reports

• Audit utilizing a comprehensive method G&A files records and reports to ensure they are prepared according to established guidelines. Evaluate recommend communicate and execute process improvements to streamline workflow and enhance ability to meet established guidelines.

• Carry and manage a modified caseload when necessary.

• Participate in the staff selection process.

Qualifications

Required

• Bachelors Degree or equivalent or an equivalent level of experience in a health or insurance related industry. Required

• 5 years of relevant experience in a related Appeals & Grievance role with complex and/or team lead responsibilities. Required

Preferred

• 5 years of relevant experience in managed care or health insurance Preferred

• 2 years of relevant experience in project management or process improvement Preferred

• Extensive knowledge of managed care products and regulatory and accreditation requirements; maintain knowledge of policies and procedures including medical policies which may impact the grievance appeal and review processes Preferred

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our topnotch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• Ondemand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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