Director, Appeals and Grievances
Director, Appeals and Grievances
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USD 133000 - 155000
1 Vacancy
Job Description
At MVP Health Care were on a mission to create a healthier future for everyone which requires innovative thinking and continuous improvement. To achieve this were looking for a Director Appeals & Grievancesto join #TeamMVP. This is the opportunity for you if you have a passion for health equity transformation & being the difference for the customer.
Whats in it for you:
- Growth opportunities to uplevel your career
- A peoplecentric culture embracing and celebrating diverse perspectives backgrounds and experiences within our team
- Competitive compensation and comprehensive benefits focused on wellbeing
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District one of the Best Companies to Work For in New York and an Inclusive Workplace.
Qualifications youll bring:
- 4year undergraduate degree.
- 5 years related experience. Previous customer service experience preferably in health insurance HMO or appeals environment. Demonstrated leadership skills including the abilities to motivate develop and support a team of staff
- Experience leading and managing projects and policy and procedure changes including coordination of activities and initiatives across departments
- Demonstrated ability to work in a fastpaced environment and manage staff to both meet and exceed goals and key performance measures
- Passionate about customer service with a continuous improvement mindset
- Excellent problem solving trend identification and analytical skills with a demonstrated ability to solve problems effectively and efficiently
- Ability to advance ideas even in the face of resistance and act as a change agent
- Commitment to high ethical standards in all work; protects the privacy of members and MVP data and exercises discretion in handling confidential member information
- Excellent oral and written communication skills including presentation skills
- Demonstrated PC skills using Microsoft applications
- Ability to travel to other office locations
- Willingness to work a flexible schedule
- Curiosity to foster innovation and pave the way for growth
- Humility to play as a team
- Commitment to being the difference for our customers in every interaction
Your key responsibilities:
- Oversee the development training and performance management of a team that will report across the grievance and appeals department
- Conduct audits and recommended process improvements that address organizational noncompliance and lead to passing all DOH surveys while avoiding any sanctions
- Implement programs and technology to improve member engagement; leverage internal resources and enhance member outreach processes that eliminate case backlog
- Ability to track appeals and grievances and evaluate present and potential future resources to successfully implement and manage timely resolution
- Collaborate with provider relations and claims teams as well as Medical Directors Pharmacy Benefits Managers and thirdparty administrators to achieve resolution of appeals and grievances
- Manage the development of data collection and reporting systems to capture grievances and appeals data in line with CMS and DOH reporting regulations.
- Spearhead any investigations and prepare recommended responses to grievances referred to the plan from regulatory entities including but not limited to the DOH CMS and Department of Financial Services
- Develop standards and criteria for monitoring compliance with regulatory requirements and professional standards across all programs
- Other duties as assigned by leadership.
- Contribute to our humble pursuit of excellence by performing various responsibilities that may arise reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where youll be:
Virtual with the ability to travel to HQ for team meetings as necessary.
Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors including but not limited to geographic location; relevant experience education and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
MVPs Inclusion Statement
At MVP Health Care we believe creating healthier communities begins with nurturing a healthy workplace. As an organization we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits employs trains compensates and promotes without discrimination based on race color creed national origin citizenship ethnicity ancestry sex gender identity gender expression religion age marital status personal appearance sexual orientation family responsibilities familial status physical or mental disability handicapping condition medical condition pregnancy status predisposing genetic characteristics or information domestic violence victim status political affiliation military or veteran status Vietnamera or special disabled Veteran or other legally protected classifications.
To support a safe drugfree workplace preemployment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability please contact our Talent team atemailprotected.
Other details
- Job FamilyMedical Management/Clinical
- Pay TypeSalary
- Min Hiring Rate$133000.00
- Max Hiring Rate$155000.00
Required Experience:
Director
Employment Type
Full-Time
