9901 - Signature Advantage

9901 – Signature Advantage

Louisville, KY, US, 40299

Description:

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Signature Advantage, a subsidiary of Signature Healthcare, is an Institutional Special Needs Plans (I-SNP) which is a Medicare Advantage Plan. As an I-SNP, we provide a Medicare Advantage plan for people who are eligible for Medicare and who reside in our partner nursing facilities.

Our Sacred Seven Values of Heroic, Compassion, Teamwork, Respect, Integrity, Patience and Positivity make this an incredible place to serve and make a difference in the lives of our patients, residents, Stakeholders and communities!

How you will make a difference:

* Assist in Grievance and Appeals Process for Medicare Advantage plan. Interface with internal departments and external vendors to include but not limited to, Grievance and Appeals Committee, Medical Management, our claims system and internal Databases.

How you will spend your time:

* Meet the physical and sensory requirements stated below and be able to work in the described environment.
* Participate in process improvement initiatives that improve the customer experience, enhance workflow, and/or improve the work environment.
* Work closely with the data team to build, maintain and reconcile provider database.
* Review and analyze incoming provider Applications and prepare them for submission to CAQH.
* Track, Monitor and resolve Grievance and Appeals Cases.
* Maintain Log of Grievance and Appeals cases for tracking and CMS reporting purposes.
* Track, Monitor and resolve Grievance and Appeals Cases.
* Maintain Log of Grievance and Appeals cases for tracking and CMS reporting purposes.
* Ability to translate business-reporting requirements into production and database reports.
* Assist in creating report mockups and templates from business requirements when necessary.
* Work Collaboratively in cross-functional teams.
* Interface with and understand analytical reporting needs of the business stakeholder.
* Other special projects and duties, as assigned.

The qualifications you will need:

* Associate’s degree in HealthCare Management and/or equivalent related experience preferred.
* Experience with extracting data, drawing conclusions, and reporting for leadership to review
* Experience with Medicare Advantage Grievance and Appeals processes and requirements.
* Experience with Microsoft Office products.
* Customer service oriented with the ability to work well under pressure.
* Effective verbal and written English communication skills
* Highest level of professionalism with the ability to maintain confidentiality.
* Ability to communicate with members and providers in a compassionate and factual manner.
* Ability to communicate at various levels of organization and work well within a team environment in support of company objectives.
* Strong attention to detail and accuracy, excellent organization skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
* Strong analytical and problem-solving skills.
* Ability to take initiative and make suggestions for improvements.
* Ability to deal with new tasks without the benefit of written procedures.
* Approachable flexible and adaptable to change.
* Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.

Your work environment:

* You will be required to work out of the Corporate office.

* You’ll be around other co-workers, residents and their guests.

* You’ll have possible exposure to occasional slippery floors, chemicals, sharp objects.

Physical and Sensory requirements:

* This role requires moderate physical activity.

* Standing and/or walking for more than two (2) hours per day.

* Sitting for more than two (2) hours at a time.

* Bending and/or stooping for more than one (1) hour at a time.

* Requires writing and/or computer work with repetitive typing and concentrating on computer screen and/or documents for more than two (2) hours at a time.

Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories.