Appeals & Grievance Analyst - HAP
Education Required:
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Associate’s Degree in health care, business or related field required or an additional two (2) years of related and relevant experience in processing grievances and/or complaints related to managed care may be considered in lieu of the degree
Experience Required:
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Minimum of one (1) year of experience working in a managed care facility in customer service processing appeals and grievances, in utilization management processing authorizations and/or compiling data for appeal review with regulatory entities
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Research experience
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Special emphasis in written communication and customer service skills.
Preferred:
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Minimum of two (2) years’ experience processing grievances and complaints within a managed care setting. Experience working in a managed care call center capacity may substitute for one year of the minimum required experience.
Assessment Required:
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Successfully complete Microsoft Word assessment in the 70th percentile
Skills and Abilities:
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Must demonstrate strong analytical and critical thinking skills
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Must demonstrate excellent problem solving techniques
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Must possess a very high degree of patience, maturity, empathy, tact and diplomacy and be able to work with all levels of people within the organization
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Must possess a high degree of poise and good judgment in responding to inquiries from customers with varying attitudes and have excellent written, listening and verbal communication skills Must be flexible and handle multiple priorities through organizational and time management skills
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A demonstrated ability to work in a Windows environment, HAP’s current documentation system (Pega-A&G and CRM and Microsoft Word
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Demonstrated knowledge of the Medicare Advantage, Federal Government, Medicare benefits, all Commercial including Self-Funded benefit guides, contracts and riders, eligibility and direct pay programs and rates
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Demonstrated knowledge of billing/claims and customer service functions in a healthcare environment
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Knowledge of medical terminology
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.