Wednesday , September 22 2021

Anthem Blue Cross Careers – Manager Grievance/Appeals

Website Anthem

Job Description:

Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.

Job Responsibilities:

  • Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.
  • Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
  • Addresses both internal/external customer/provider needs, and concerns related to team activities.
  • Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Job Requirements:

  • BA/BS degree; 5+ years related experience; or any combination of education and experience, which would provide an equivalent background.
  • Time Management skills is essential.
  • Requires a current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification.
  • Must possess strong research skills and perform well independently and in a team setting.
  • Medicaid Commercial business products knowledge/experience a plus.
  • WGS and FACETS experience preferred.
  • Proficiency in Microsoft Word, Excel and SharePoint preferred.
  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Details:

Company: Anthem

Vacancy Type:  Full Time

Job Location: Roanoke, VA, US

Application Deadline: N/A

Apply Here

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