Appeals Analyst Supervisor - Priority Health

Job Summary

Priority Health is seeking an Appeals Analyst Supervisor. The Appeals Analyst Supervisor is responsible for managing, supporting, and oversight of the Appeals and Grievance team. This includes analyzing, evaluating, and implementing corrective measures to improve performance and ensure compliance with laws, regulations, and other accreditation requirements, as well as, executing upon the operational and strategic plans to achieve expected performance. The Appeals Analyst Supervisor provides leadership to direct reports and lead process improvement initiatives. Developing action plans & performance goals, identifying coaching and development needs, and providing guidance and support to ensure that the goals and standards of the department are being met are key responsibilities.

Essential Functions

• Ensure that the Appeals & Grievance department processes all appeals, grievances, and complaints in accordance with standards and the organization's policies and procedures. Works with all key departments and external partners to ensure all are up to date with regulatory, departmental, and organizational changes impacting the appeals and grievances processes.

• Supervise the day-to-day operations of the Appeals and Grievance staff and functions within the department ensuring productivity and quality metrics are met. Monitor and distribute team's caseload and ensure adequate coverage including after hours and weekend coverage/on call coverage.

• Lead and manage team members with onboarding, training, mentoring and work assignments. Support staff development through goal setting, training, communication, accountability, etc.

• Develops, implements, maintains, and reviews the adequacy of appeal and grievance systems, reporting, policies, and functions to achieve stated goals, including, but not limited to case resolution and timely responsiveness and applicable accreditation standards to ensure compliance with all relevant regulatory requirements.

• Ensure timely and effective data collection, summarization, integration, and reporting, including, but not limited to, productivity, status, and trend reports

• Audit, utilizing a comprehensive method, G&A files, records, and reports to ensure they are prepared according to established guidelines. Evaluate, recommend, communicate, and execute process improvements to streamline workflow and enhance ability to meet established guidelines.

• Carry and manage a modified caseload when necessary.

• Participate in the staff selection process.

Qualifications

Required

• Bachelor's Degree or equivalent or an equivalent level of experience in a health or insurance related industry. Required

• 5 years of relevant experience in a related Appeals & Grievance role with complex and/or team lead responsibilities. Required

Preferred

• 5 years of relevant experience in managed care or health insurance Preferred

• 2 years of relevant experience in project management or process improvement 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

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

Department Name

Employment Type

Shift

Weekly Scheduled Hours

Hours of Work

Days Worked

Weekend Frequency

CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.