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.
- 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.
- 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.
Vacancy Type: Full Time
Job Location: Roanoke, VA, US
Application Deadline: N/A