AmeriHealth Caritas Grievance & Appeals Team Lead in Palm Beach Gardens, Florida
Grievance & Appeals Team Lead
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
NOTE TO APPLICANTS: This position will be physically located in our Palm Beach Gardens, FL office.
Under the general direction of the Supervisor of Grievance and Appeals, the Grievance and Appeals Team Lead is responsible for assisting the Grievance and Appeals team with questions and for assisting the Grievance and Appeals Supervisor with reports and projects as outlined below. The Grievance and Appeals Team Lead demonstrates solid knowledge of Grievance and Appeals systems, Provider Complaints database for which G/A is responsible, Medicaid Fair Hearings process and tracking, Grievance and Appeals departmental policies, and the AHCA website including handbooks, member rights and responsibilities, and state regulations applicable to the grievance and appeals process. The Grievance and Appeals Team Lead will have a very active role in departmental meetings, training, and quality oversight.
- Assists G/A team with questions that arise pertaining to the intake or resolution of a grievance or appeal, departmental policies, and any other questions that arise that are pertinent to G/A functions.
- Identifies trends in member dissatisfaction and escalate to Supervisor to be reported to appropriate entities/committees.
- Monitors inventory to ensure assigned cases do not exceed regulatory timeframes.
- Identifies opportunities for staff development and training and elevates to Supervisor.
- Serves as a Subject Matter Expert and conducts training as required. Conducts cross training to staff as required.
- Assists with G/A reporting as determined by Supervisor.
- Communicates with other departments as needed to assist in grievance or appeal resolution.
- Assists with quality review of intake and resolution teams within the department.
- Assists with maintenance of Grievance and Appeals data within JIVA.
- Assists with ad-hoc projects as determined by Supervisor.
- 1-3 years experience in Grievance and Appeals processing preferably in Medicaid.
- Associate's Degree preferred.
- Intermediate abilities with Microsoft Office Suite, particularly Excel, Access, PPT.