MeridianRecruiter Since 2001
the smart solution for Meridian jobs

Supervisor - Grievance & Appeals (Provider)

Company: Blue Cross of Idaho
Location: Meridian
Posted on: July 3, 2019

Job Description:

Position Description

Supervise the day-to-day activities of staff processing member or provider Grievance and Appeals for assigned lines of business. Monitor staff workloads and assure Grievances and/or Appeals are processed in compliance with department, corporate, and applicable governing entity requirements. Assist management or related departments with education and/or developing process improvement initiatives based on Grievance and Appeal outcomes.

Position Requirements

QUALIFICATIONS: (Minimum qualifications required for the job)

--- Experience: Five years' grievance and appeals experience in healthcare or health insurance industry
--- Certifications/Licenses: CPC

Knowledge, Skills and Abilities (KSAs):

Knowledge of:
--- Medical terminology
--- Benefit structures
--- Contract language
--- Claims processing
--- Conflict management/de-escalation techniques
--- HIPPA (healthcare privacy law)
--- Medical coding

--- Strong verbal, written, and interpersonal communication
--- Organizational
--- Analytical
--- Detail Oriented
--- Problem Solving
--- Microsoft Office (Word, Excel, Outlook) - Intermediate
--- Multi-tasking

Ability to:
--- Manage multiple priorities
--- Work effectively with various levels of individuals within the organization
--- Prioritize work and manage multiple initiatives
--- Keep up-to-date on State and Federal regulations and accreditation standards
--- Give and receive constructive feedback in a team environment
--- Effectively monitor and maintain staff performance levels
--- Handle diverse activities on a daily basis
--- Effectively manage and lead through change

Preferred Requirements:
--- Supervisory experience
--- Facets claims processing experience; Pharmacy claim systems experience
--- Knowledge of Inter-Plan Teleprocessing (ITS), Federal Employee Health Benefits Program (FEP), Medicare processes
--- Business writing experience in a health insurance or legal environment
--- Functional working knowledge of Department of Labor, Department of Insurance, and Centers for Medicare and Medicaid (CMS) programs and guidelines governing grievances and appeals processing.
--- Functional working knowledge of healthcare entity accreditation standards and practice (such as NCQA, Joint Commission, etc.), Federal Health Care Reform regulations concerning complaints, grievances, appeals, and privacy, and operational and professional policies and detailed understanding of Blue Cross of Idaho (BCI) procedures and various policy benefits and provisions.

Position Reports to: Director Grievance & Appeals
Internal Job Posting: 6/14/2019 - 6/21/2019
External Job Posting: 6/14/2019 - until filled

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Keywords: Blue Cross of Idaho, Meridian , Supervisor - Grievance & Appeals (Provider), Other , Meridian, Idaho

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Other Jobs

Need a Change? Work From Home !!
Description: Are You Motivated Be part of the Largest Health Benefits Discount company in the nation and assist people to
Company: MAH Benefits
Location: Boise
Posted on: 07/25/2019

AIMM Executive
Description: The AIMM Business Development Lead BDL is responsible for delivering accelerated sales growth for the Services business through the CES Profit Centers. This role is responsible for the sales strategy (more...)
Company: CES Columbia Division
Location: Boise
Posted on: 07/25/2019

Call Center Representative.
Description: Teleperformance is now hiring Customer Care Professionals in the Boise, ID area Teleperformance is a global leader in providing exceptional omnichannel customer
Company: Teleperformance
Location: Garden City
Posted on: 07/25/2019

Tired of the 9 to 5?
Description: Are You Ready for a Change We are seeking very motivated, responsible and fun individuals to join
Company: MAH Benefits
Location: Boise
Posted on: 07/25/2019

Underground Utility Superintendent
Description: Job Posting TitleUnderground Superintendent THIS POSITION WILL BE BASED IN BOISE, ID BUT WILL TRAVEL THROUGHOUT THE STATE OF IDAHO Company:Probst Electric is one of North America's premier electrical (more...)
Company: Probst Electric
Location: Boise
Posted on: 07/25/2019

Bid On Local Remodeling Jobs - Reach New Customers In Your Area
Description: Over 25 million homeowners have trusted HomeAdvisor 1800Contractor to help them find quality professionals with the expertise to turn their home improvement
Company: HomeAdvisor
Location: Boise
Posted on: 07/25/2019

Description: SPA LUMOS LLC, a Lash Skin Boutique in Boise, ID is searching for an Idaho Licensed Esthetician to join our team This is an amazing opportunity to join an innovative spa that will challenge and inspire (more...)
Company: Spa Lumos
Location: Boise
Posted on: 07/25/2019

Environmental Chemist
Description: We are looking for a qualified candidate to join our team in the Inorganics department. This is an entry level position and would involve sample preparation, analysis of samples, and quality control. (more...)
Company: Analytical Laboratories Inc
Location: Boise
Posted on: 07/25/2019

Call Center Specialist in Boise, ID.
Description: Teleperformance is now hiring Customer Care Professionals in the Boise, ID area Teleperformance is a global leader in providing exceptional omnichannel customer experiences since
Company: Teleperformance
Location: Garden City
Posted on: 07/25/2019

Start working from home TODAY !
Description: Seeking Health Care Associates to Start a HOME OFFICE POSITION Leading Health Care and Dental Benefits Discount
Company: MAH Benefits
Location: Boise
Posted on: 07/25/2019

Log In or Create An Account

Get the latest Idaho jobs by following @recnetID on Twitter!

Meridian RSS job feeds