What are the responsibilities and job description for the Appeals Specialist - Temporary position at McLaren Integrated HMO Group?
About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Appeals Specialist - Temporary
Michigan, Flint
NEW
Administrative/Clerical
McLaren Integrated HMO Group
26000567
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Appeals Specialist to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Position Summary:
Responsible for assisting with coordination of all appeal/grievance activity for the Plan. Responsible for ensuring departmental compliance with applicable regulations and tracking appeal and grievance activity, complying with state and regulatory standards. Assists in preparing and researching case files as necessary. Responsible for research and resolution of member and provider claims issues. Responsible for assisting with member and provider education opportunities regarding complaints/grievances/appeals. Identifies process improvement opportunities and develops plans to address opportunities.
This is a hybrid position with requirements to come on site as scheduled, Flint, MI.
Qualifications:
Required:
- High School Diploma or equivalent (GED).
- One (1) year experience in healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.Preferred:
- Associate degree in business, health care or related field.
- Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, regulatory compliance, claims processing, membership/eligibility).
- Two (2) years' healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.
Additional Information
- Schedule: Full-time
- Requisition ID: 26000567
- Daily Work Times: 8:30 am - 5:00 pm
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.