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iMPact Business Group
https://cdn.haleymarketing.com/templates/62439/images/impact-200x200.png
http://www.impactbusinessgroup.com
http://www.impactbusinessgroup.com
USD
20.00
22.00
HOUR
true
Grievance Analyst
Grand Rapids, MI 49525 US | Fully Remote TELECOMMUTE US
Posted: 01/25/2024
2024-01-25
2024-02-29
Job Type:
Contract
Industry: Other (HR, Admin, Mkt, Sales)
Job Number: 24176
Pay Rate: $ 20.00 - $ 22.00
Job Description
Our client is a nationally recognized not-for-profit health system, offering a full continuum of health services through their health plan, medical group, and hospital group.
Our client is looking for a Grievance Analyst.
- 100% Remote
- Remote work for this position may be approved based on policy and business considerations. Some states are not eligible for remote work (CA, CT, MA, NJ, NY, Washington D.C.)
- The length of this contract is set for 3 months.
- Equipment provided
Summary:
- Effectively administer all steps of the grievance and review processes for non-Medicare products pleasantly and expediently to ensure quality customer service and compliance with all legislative, regulatory, and accreditation requirements. Assist customers throughout the process by providing complete information and follow-up on a timely basis. Ensure committee, State, and Federal decisions are properly implemented.
- Responsible for the analysis, research, and completion of complex member appeal investigations. Effectively administer all steps of the member appeal and fair hearing review processes for all non-Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, gathering relevant information from enterprise-wide systems, and collaborating to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory, and accreditation requirements.
- Assist customers and staff throughout the process by providing complete information and follow-up on a timely basis. Ensure committee, State, and Federal decisions are properly implemented. Assist the Lead, Supervisor, and/or Manager in coordinating activities and in the development/collection of materials required to meet and demonstrate compliance with all state, federal, and accrediting organization requirements. Prepares and presents education to internal departments. Serves as a mentor/trainer to other team members.
- Apply strong analytical skills and business knowledge to investigate, analyze, and recommendation of solutions Communicate, collaborate, and act as a consultant to internal and external customers to resolve complex issues.
Job Requirements
Qualifications:
- Required Associate's Degree or equivalent
- Preferred Bachelor's Degree or equivalent
- 5 years of relevant experience in Grievance & or Appeal Analyst or related experience Required
- 3 years of relevant experience in Member or Provider Customer service, Claims, Legal, and/or enrollment/eligibility Preferred
- Working knowledge of Health systems for claims payment, care management, authorizations, customer service interactions, pharmacy, Rx profiles, medical policies, and plan documents for all non-Medicare product lines (Commercial Group, Commercial individual, Insurance Company, Self-funded, Government Programs - Medicaid) Preferred
- Extensive knowledge of managed care products and regulatory and accreditation requirements; Maintain knowledge of policies and procedures, including medical policies which may impact the grievance, appeal, and review processes Preferred
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Ready to embark on an exciting career journey in the vibrant city of Grand Rapids, Michigan? Explore our latest job opportunities in this dynamic region that boasts a thriving job market and a welcoming community. Known as Beer City USA, Grand Rapids is home to an array of craft breweries, stunning art galleries like the Frederik Meijer Gardens & Sculpture Park, and impressive cultural attractions such as the Grand Rapids Ballet and the Grand Rapids Symphony. With its lively downtown area, renowned restaurants serving up local delicacies like pasties and Michigan cherry pie, and picturesque outdoor spaces like Millennium Park and John Ball Zoo, Grand Rapids offers a perfect blend of urban amenities and natural beauty for professionals looking to advance their careers in a charming and growing city. Dive into our job listings and discover the opportunities waiting for you in Grand Rapids!
