Associate Director Grievances and Appeals Bilingual English/Spanish Work at Home FL

Profile

Description

The Associate Director, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Associate Director, Grievances & Appeals requires a solid understanding of how organization capabilities interrelate across department(s).

Responsibilities

The Associate Director, Grievances & Appeals assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), andcould lead multiple managers or highly specialized professional associates.

Required Qualifications

Bachelor's Degree or Equivalent job experience ( 5 years)

Five or more years of management experience

Must have experience in the healthcare industry or medical field

Advanced experience with Microsoft Word and Excel

Experience handling multiple projects and assignments as directed by Management

Capacity to maintain confidentiality and work independently in support of the department

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing

Preferred Qualifications

Strong knowledge of CMS Grievances regulations

Additional Information

Schedule: Monday to Friday from 8 am to 5 pm. Overtime as per business needs.

Training: 8 weeks of virtual training

Work Location (Address): Work at Home FL

% Travel: 20% Tampa for meetings, or to other States for training .

# of Direct Reports : 4 for now but this number may change.

Language Proficiency Testing (English/Spanish): Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Strong verbal and written communication skills

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com