Ciudad Autónoma de Buenos Aires - hace 5 días

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Associate Director, Grievance and Appeals page is loaded

Associate Director, Grievance and Appeals Apply locations Banner Univ Corp (2701 E Elvira Rd) Remote Phoenix AZ time type Full time posted on Posted 4 Days Ago job requisition id R103550

Primary City / State :

Tucson, Arizona

Department Name : Grievances & Appeals

Grievances & Appeals

Work Shift : Job Category :

Job Category : General Operations

General Operations

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options.

If you’re looking to leverage your abilities you belong at Banner Health.

In this position of Associate Director, Grievance and Appeals - you will have 5 - 8 Grievance and Appeals coordinators assigned to you.

Duties include managing appeals, disputing inventory, assigning work and monitoring / auditing case decisions. This position is responsible for maintaining AHCCCS regulatory compliance with member and provider communication.

You will work on developing and growing coordinator's for growth within the department or Banner. You will oversee the AHCCCS State Fair Hearing process, including representing the plan from an administrative aspect.

You will work hand in hand with Grievance and Appeals Medical Directors in regards to trends and analysis. Business hours are 8AM-5PM, the nature of Grievances and Appeals will include night and weekend check ins, this department has regulatory requirements that do not exclude weekends.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County.

Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position is responsible for assisting with ensuring ongoing compliance and operational performance of new and extant Medicaid, Medicare and Commercial programs and projects.

Works both independently and collaboratively with all health plan functional areas with the purpose to support the development, implementation, maintenance, monitoring, and continuous improvement of the Medicaid, Medicare and Commercial lines of business.

Must possess advanced organizational and matrixed management skills to manage the highly complex ongoing and periodic processes including but not limited to the dissemination and verification of the implementation of regulatory and sub-regulatory guidance and rule changes issued by the products’ regulatory authorities, filing various documents, forms and responses to each regulatory authority and management of many periodic processes including but not limited to Medicaid, Medicare and Commercial program bid submission, periodic Service Area Expansions, MA and HIX Call letter implementation, annual readiness review attestation, and Commercial product and rate development.

This position may be responsible for supervising and directing Medicaid, Medicare and Commercial Programs that provides the clerical and technical support for the Health Plans.

CORE FUNCTIONS

1. Ensures all Medicaid, Medicare, MA and Commercial (both on and off the exchange) regulatory, sub-regulatory and policy guidance are disseminated in a timely manner and that such guidance is strictly adhered to, implemented and monitored and that evidence of implementation is verified and documented.

2. Manages the annual Medicaid, Medicare, and MA Bid process and periodic Commercial product and rate development. Manages the Service Area and Market Expansion process as necessary.

3. Manages or oversees the submission of all required materials and forms (i.e. Formulary Submission, annual website updates, marketing materials, Low Income Subsidy (LIS) match rates, monthly encounter data and Part C and D reporting, Policies, Evidence of Coverage) and data to the regulatory body overseeing a particular line of business.

4. Manages the development of the New Member Notifications. Assists Marketing with the production of all member materials for the Medicaid, Medicare and Commercial lines of business.

Assists all functional areas with ensuring they are using the most current model member communications.

5. Attends all relevant AHCCCS, CMS, ADOI and CCIIO user group calls and meetings.

6. Assists with researching and tracking the Medicaid, Medicare and Commercial legislative environment and initiatives in collaboration with Legislative Affairs.

Ensures the regulatory reporting requirements for the Medicaid, Medicare and Commercial lines of business are timely, accurate and compliant.

7. Manages the production of the Monthly Operational Dashboard. Ensures functional areas are compiling and reporting the data that comprise the Monthly Medicare Compliance Dashboard.

8. Collaborates with Network Development to ensure Medicaid, Medicare and Commercial Provider contracts meet regulatory requirements.

9. Provides process / program management and coordination to Health Plan teams / workgroups. Includes partnering with project and clinical leaders across the organization.

Requires interactions with all levels of staff, management and physicians.

MINIMUM QUALIFICATIONS

Must possess a knowledge as normally obtained through the completion of a Bachelor’s degree in health care administration, finance administration or project management or equivalent combination of work experience.

This position requires the skills, knowledge and abilities typically acquired over one year of related experience and education.

The work requires a high degree of organization, the ability to manage time and resources effectively, and the self-starter ability to work independently to achieve goals.

Effective customer service and interpersonal relations skills are necessary. The ability to communicate effectively verbally, in writing and through common computer software is required.

PREFERRED QUALIFICATIONS

Health Plan and Case Management experience and prior experience working in Medicaid and / or Medicare health plans preferred

Additional related education and / or experience preferred.

EOE / Female / Minority / Disability / Veterans

Our organization supports a drug-free work environment.

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About Us

Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve.

Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better.

The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

COVID-19 Vaccine Requirements

The safety of our team members and patients is of utmost importance, so Banner is requiring the COVID-19 vaccine for all team members, with a deadline to become fully vaccinated by Nov.

1, 2021. As members of the health care field, we are in the business of caring for people, so we take seriously our commitment to ensure our patients and teams are safeguarded from this rapidly changing and dangerous disease.

Total Rewards

We are proud to offer a comprehensive benefit package for all benefit-eligible positions. Please visit our Benefits Guide for more information.

EOE / Female / Minority / Disability / Veterans

Banner Health supports a drug-free work environment.

Privacy Policy

Banner Health, Ciudad Autónoma de Buenos Aires

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