Supervisor, Appeal and Grievance

Supervisor, Appeal and Grievance
Wheeling, WV
Full-Time
Finance - Quality Management
Director of Clinical Quality

Responsible for supervising the beginning to end process of receiving, reviewing and assigning appeal and grievance cases. 

Acts as a subject matter expert for all lines of business for provider and member appeals and grievances. 

Supervises the handling of assigned appeals and grievances while ensuring that regulatory time frames are met in accordance with the standards and requirements established by various regulators.  Examples include but are not limited to:  CMS, BMS, DOI, NCQA and EQRO. 

  1. High school diploma; college preferred;
  2. Detail oriented;
  3. Project or supervisory experience;
  4. Excellent customer services skills;
  5. Ability to work independently and as part of a team;
  6. Excellent time management skills with the ability to meet regulatory guidelines;
  7. Proficient in Microsoft Office products;
  8. Ability to review, understand and apply the provisions of policies and procedures.

  1. Knowledge of managed care state and federal guidelines and regulations;
  2. Previous experience in managed care setting;
  3. Familiar with medical terminology, ICD 10 and CPT coding;
  4. Previous supervisory experience.

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org