Senior BPM Lead (Appeals & Grievances Supervisor)

UST


Date: 1 week ago
City: Taguig
Contract type: Full time
Role Description

The Appeals and Grievances Supervisor will ensure that cases are assigned and documented in the highest quality possible and conduct tracking and trending activities to ensure identified issues are communicated to the appropriate business leader.

  • Monitor inventory and assign work to analysts
  • Directly supervise staff in accordance with company policies
  • Maintain oversight of casework to ensure Appeals and Grievances move through each review level without delay, and ensure all cases are processed timely to meet A&G SLAs
  • Mentor analysts and assist with providing case guidance and direction as needed
  • Participate with QA programs to implement and maintain continuous quality improvement
  • Bring to management’s attention any system or process issues determined during the investigation of the appeal or grievance
  • Drive operational excellence into all processes and departmental interactions based on CMS and requirements
  • Demonstrate excellent working knowledge of Appeals and Grievance regulations and CMS guidance, and ability to convey this knowledge to analysts
  • Develop and implement effective strategies that enables the department to maintain efficient and cost-effective processes
  • Partner with other teams/departments to promote continuous feedback and quality improvement

Qualifications

  • Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree
  • At least 2 years of experience in a supervisory or management role within the Medicare healthcare industry (preferably Claims)
  • At least 3-5 years of experience in a grievance and appeals environment
  • In-depth knowledge of CMS Grievance and Appeals regulations
  • Strong analytical, organizational, planning and problem-solving skills
  • Ability to effectively interface with employees at all levels
  • Ability to read and interpret policies and procedures
  • Ability to work in a fast-paced environment and lead staff to success
  • Strong focus to drive and serve the customer
  • Claims processing or medical billing/coding experience an advantage

Skills

Medical Management,Team Management,Appeals & Grievances

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