Manager, Home Health Grievances – Appeals
Humana
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $86,300 - $118,700 per year
About the role
- Manage client denials and concerns by conducting a comprehensive analytic review
- Deliver final determination based on analytical skills and partnerships
- Guide the overall audit, appeal and review process to preserve revenue
- Provide direction to clinical and operational leadership regarding audit trends
- Collaborate in the development of an education plan to improve processes
- Monitor and analyze data to improve clinical documentation
- Direct workflow process and assignments for timely submissions
- Lead audit activity and development of appeal strategies
- Review medical records for Administrative Law Judge hearings
- Ensure compliance with regulatory agencies and maintain confidentiality
- Perform job responsibilities with a positive team-oriented attitude
Requirements
- Thorough knowledge of health care policy, industry and related clinical practice
- Project management principles and clinical policy development/implementation
- Knowledge of all Medicare regulations and appeals processes
- Analytical skills with ability to interpret and apply regulatory requirements
- Excellent verbal/written communication and presentation skills
- Knowledge of Payer requirements, ADR requests, Denials, Appeals, RAC/ZPIC and CERT responses
- Must be able to work well independently and in a team environment
- Excellent communication and organizational skills
- Strong attention to detail
- Must read, write and speak fluent English
- Bachelor or Associate degree in Nursing or Other Health Care related fields
- Professional License in current state of residence
- Minimum 5 years’ experience in health care management
Benefits
- Health insurance
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Volunteer time off
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
analytical skillsproject managementclinical policy developmentregulatory requirements interpretationhealth care policy knowledgeMedicare regulationsPayer requirementsaudit activityclinical documentation improvementdata analysis
Soft Skills
communication skillsorganizational skillsattention to detailteam-oriented attitudeindependent workcollaborationpresentation skillspositive attitudeleadershipproblem-solving
Certifications
Professional LicenseBachelor degree in NursingAssociate degree in NursingHealth Care related fields