Manager Appeal & Grievance (Hybrid - Troy, MI) - Health Alliance Plan
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in Health Care, Business or related field required. Master’s Degree preferred.
- Minimum of four (4) years combined customer service and professional experience in health care, call center, business and/or insurance environment or capacity required.
- Minimum of four (4) years of experience with Appeals and Grievances and demonstrated knowledge of HMO and PPO products and CMS regulations and
guidelines for Medicare products required. - Minimum of two (2) years of project coordination or project management and data analysis, validation and reporting required.
- Minimum of one (1) year of CMS Plan or Data Validation Audit experience; NCQA site visit experience preferred.
CERTIFICATIONS/LICENSURES REQUIRED:
- Certified in Health Care Compliance preferred.
SKILLS AND ABILITIES: - Proven managerial skills which include ability to lead teams effectively through a coaching methodology.
- Strong organizational and communication skills, both verbal and written and the ability to express ideas logically, cogently and persuasively.
- Ability to develop and implement recommendations and strategies, make independent judgments and effectively manage multiple responsibilities within
multiple distinct operations. - Excellent analytical and decision-making skills.
- Ability to comprehend and suggest modification to technical computerized systems or other applications as they relate to call center operations.
- Skills to learn in detail the HAP policies, procedures and benefits.
- Skills to develop a good understanding of the health care system and the HAP provider network.
- Thorough understanding of the HMO and Medicare Managed Care delivery systems.
- Extensive knowledge of State, DOL, NCQA and CMS guidelines as related to grievances/appeals and Medicare program regulations.
- Strong human relations skills.
- Technical understanding of database oriented systems.
- Proficient with Word, Excel and/or Access.
- Basic understanding of accounting principles.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.