Health Care Service Corporation
Job Description
Job Opportunity Manager, Appeals and Grievances – Oklahoma Medicaid 4/2/21Full-Time RegularOK – Oklahoma City Refer Save Apply Job ID: EG-1041263 Description: JOB PURPOSE: This position is responsible for leading, managing, planning and all Oklahoma Medicaid appeals and grievance activity (Medicaid; clinical and non-clinical). Assures operations are in compliance with regulatory, sub-regulatory and accreditation standards. Oversee coordination of the Medicaid managed care regulations and program changes and ensure that regulatory or contractual updates have been implemented. Oversee coordination of the contract requirements with Oklahoma Health Care Authority. Also has overall authority to provide direct input and direction into the operational functions of Medicaid customer service to ensure integrated and quality customer service intake specific to all clinical and non-clinical organizational and coverage determinations.JOB REQUIREMENTS:* Bachelor’s Degree and 4 years health insurance experience in contract benefits, claims, medical review or appeals. * Leadership skills to manage staff and work across the organization. * Experience delivering presentations to physicians, legal personnel and committees.* Analytical skills to analyze data and prepare reports. * Knowledge and understanding of the health care industry and regulatory requirements.* Experience writing policies and procedures.* Written and verbal communication skills.* Ability and willingness to occasional travel.PREFERRED JOB REQUIREMENTS:* Knowledge of Medicaid* Knowledge of claims, membership or customer service operations* Experience in managing teams in multiple locations* Audit experience.* Knowledge of accreditation requirements regarding appeals and quality management. HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Requirements: Expertise Other, Claims & Customer Service Other, Claims & Customer Service Job Type Full-Time Regular Full-Time Regular Location OK – Oklahoma City OK – Oklahoma City