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Supervisor, Appeals (Children's Specialty Plan)

Company: Oklahoma Complete Health
Location: BLANCHARD
Posted on: May 3, 2021

Job Description:

Position Purpose: Manage the day to day operations of the Appeals staff and functions within the Medical Management department. Complete weekly and monthly denial and appeal reporting requirements.

  • Ensure that the Appeals department processes all denials, appeals, and retrospective reviews in accordance with NCQA standards and time frames and state Medicaid contractual requirements.
  • Provide feedback for problem resolution for appeals staff regarding denials and appeals including assisting with the implementation of process changes, ensuring appropriate usage of resources in order to ensure compliance with NCQA and state Medicaid program guidelines, etc.
  • Conduct monthly chart audits of Assist Appeals staff to ensure compliance with NCQA and state Medicaid program requirements
  • Monitor denials and appeals through data trending reports
  • Utilize developed policies and procedures to standardize daily operations of the appeals processes
  • Identify opportunities for process improvements
  • Educate/train staff as needed to ensure consistent performance and adherence to standards
Education/Experience: Bachelors degree or equivalent experience. 3+ years of behavioral health experience. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Oklahoma Complete Health, Norman , Supervisor, Appeals (Children's Specialty Plan), Other , BLANCHARD, Oklahoma

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