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Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Supervise the functions of Grievance and Appeals (A&G) analysts and administrative support staff. Responsible for training, daily oversight, queue monitoring and caseload supervision of A&G analysts.
Provide assistance and guidance to internal and external customers regarding grievance / appeals policies and procedures.
Ensure customer satisfaction and help establish best practices.
Essential Responsibilities :
Supporting Responsibilities :
Work Experience : Minimum three years of experience in the healthcare or health insurance industry. Active problem resolution and people management experience preferred.
Experience in Grievance and Appeals processes preferred.
Education, Certificates, Licenses : High school diploma or equivalent required. Bachelor's degree preferred.
Knowledge : Strong knowledge of Medicare / Medicaid benefits, program structure and HIPAA laws / regulations. Strong understanding of grievance / appeal regulations for Medicaid and Medicare programs.
Intermediate-advanced proficiency in Microsoft Office Applications including Word and Excel and call tracking software, mainframe and medical management software.
Basic-intermediate knowledge of medical terminology and medical coding. Knowledge of claims, authorization methodology, and provider networks.
Excellent business writing skills. Excellent time management and diplomatic skills. Excellent communication style with subordinates, colleagues and other business partners.
Bilingual (Spanish) preferred.
Building Trust
Building a Successful Team
Aligning Performance for Success
Building Customer Loyalty
Building Strategic Work Relationships
Continuous Improvement
Decision Making
Facilitating Change
Leveraging Diversity
Driving for Results
Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Skills :
Accountable leadership, Communication, Communication (written / verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills / Planning and Organization
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :
Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.
Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Last updated : 2024-06-15
Full Time
$74k-93k (estimate)
06/17/2024
06/25/2024