(Archived) MGR- Appeals & Grievance

Position: Appeals & Grievance Manager
Location: Irving, TX
Schedule: Monday-Friday 8A-5P

Job Information

• Oversee the investigation and resolution of provider disputes/appeals involving provider terminations, credentialing denials and claim denials according to state regulations.
• Develop, update and maintain corporate policies and procedures to support new lines of business and reflect changes in contract language and updates in regulations and standards.
• Develop and maintain collaborative relationships with internal and external customers.
• Design and implement company-wide training and in-services to ensure quicker resolution of member issues and a better understanding of member and provider appeal rights.
• Manage cross-functional employees to meet and exceed service requirements and functional objectives.
• Recruit, develop, motivate and retain a high caliber of team members.
• Coach and lead team to continuously improve operational performance.
• Maintain a positive work environment that supports self-direction; provide a structure to optimize the experience, skill, knowledge, and capability of the team.
• Reward team members based on contribution and performance.
• Manage budget and control expenses while meeting operational, financial and service requirements.
• Perform other duties as assigned

Requirements

• Bachelor degree Supervisory or management experience
• Medicare experience preferred
• Knowledge of managed care products, benefits and contracts
• 5 years of experience in advocacy
• Ability to interpret and implement federal and state guidelines
• Analytics ability to organize and prioritize work to meet deadlines
• Excellent written and oral communication skills, analytical and problems-solving skills, and interpersonal and teaming skills

Benefits

• Competitive salary commensurate with experience
• Medical/Dental
• Weekly Pay
• Direct Deposit
• Referral Bonuses
• Childcare reimbursement

For immediate consideration please create a profile and submit your resume through our applicant tracking system. Applications with attached resumes will be given first consideration. Visit us online at [Register to View] to learn more about our company and to view additional openings in your area.

About Us: All Medical Personnel is a national leader in healthcare staffing and recognized by Staffing Industry Analysts (SIA) as one of the nation's largest healthcare staffing firms. Our team of seasoned recruiters are experienced in their ability to recruit, screen and place medical professionals for all types of healthcare settings.