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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

Skills:
--- 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

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