Lead Appeal

GENERALSUMMARY:

The Lead Appeal & Grievance Support is responsible for daily oversight of inventory management for the Appeal & Grievance (A&G) department.

Responsible for preparing daily inventory reports to provide management with updates as needed and speak to team performance.

The Lead Appeal & Grievance Support will also be responsible for assisting with Monitoring and Oversight case reviews by reviewing all grievance and appeals cases before staff mails decision letters to members. The Lead Appeal & Grievance Support may be responsible for case investigations and back-up as needed.

The Lead Appeal & Grievance Support will assist A&G staff with determining appropriate outcomes for grievances and appeals by working with internal support departments and in accordance to regulatory guidelines. The Lead Appeal & Grievance Support will also assist with the ongoing development and maintenance of Desk Level Procedures, departmental policies and procedures, and capture data to identify trends in order to proactively address member concerns.

PRINCIPALDUTIESANDRESPONSIBILITIES:

• Act as departmental subject matter expert (SME) in order to provide guidance, direction and assistance to the A&G department Research and answer unknown benefit or procedural questions.
• Assist A&G leadership in workforce management activities, including scheduling, time off review, queue management, forecasting and providing administrative support.
• Assist with various corporate process planning, departmental projects and other outreach activities.
• Provide training support to A&G team to identify procedural information necessary for the ongoing development of the A&G team.
• Assist department leadership with external vendor management projects within A&G.
• Liaison for all system operations in order to partner with internal and external customers to resolve any issues, provide information for system updates and implementations, submit PCR, and communication with IS Helpdesk.
• Lead projects that support A&G business model activities. Ensure that all support and services delivered to internal and external customers are completed with high quality and in a timely effective manner.
• Serve as first line contact for A&G Analyst for day to day operational issues.
• Function as a liaison with plan-wide stakeholders to ensure service level agreements and workflows with internal support departments such as Membership & Billing, Health Care Management, Coordinated Behavioral Health Management, Pharmacy Care Management, Claims, Provider Services, and Sales.
• Partner with Monitoring & Oversight and Compliance to conduct and coordinate compliance training when needed and ensure that compliance information is disseminated to A&G staff, as appropriate.
• Co-facilitate in team huddle meetings.
• Weekend coverage as required for overturning authorizations to ensure timely review of appeal.
• Conduct onboarding for new and temporary team members.
• Perform other related duties as assigned.

EDUCATION/EXPERIENCEREQUIRED:

• Associate degree in business, healthcare or related field or a Registered Health Information Technician (RHIT).
• Two (2) years of Appeals investigation experience.
• Two (2) years of grievance or complaint investigation experience

Additional Details

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at

Benefits

The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.

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