Manager - Appeal & Grievance - Health Alliance Plan - Troy
- Bachelor’s degree in Health Care, Business or related field.
- Minimum of four (4) years combined customer service and professional experience in health care, call center, business and/or insurance environment or capacity
- 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
- Minimum of two (2) years of project coordination or project management and data analysis, validation and reporting
- 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
- Certified in Health Care Compliance
- Minimum of one (1) year of CMS Plan or Data Validation Audit experience; NCQA site visit experience
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
Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more at 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. Henry
Ford Health has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. 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. 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 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 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.