Work Schedule: Onsite at our downtown Birmingham office throughout the training period, then transitioning to hybrid with work-from-home opportunities.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
Tuition Assistance
Flexible Spending Accounts
Healthcare Reimbursement Account
Paid Parental Leave
Community Service Time Off
Life Insurance and Disability Coverage
Employee Wellness Program
Training and Development Programs to develop new skills and reach career goals
The Manager, Medicare Appeals and Grievances oversees the daily processing of Medicare grievances and appeals for Medicare Part C and D to ensure compliance with Centers for Medicare and Medicaid Services (CMS) regulations. This includes ensuring requirements are understood by staff and incorporated into operations as well as monitoring/auditing as needed to verify compliance. This role supervises the Medicare Appeals & Grievances specialists providing training, assistance and oversight on complex cases. This position assists the department Senior Leaders with preparation for and performance on both internal and external audits.
Key Responsibilities
Oversee the accurate and timely processing of Medicare Part C and D member appeals and grievances in accordance with the steps and timeframes required by CMS.
Ensure on-call rotation is adequately staffed to process appeals and grievances on weekends and holidays in accordance with CMS guidelines.
Directly supervise assigned team and handling of day-to-day employee issues. Assist department Senior Leadership with interviewing and hiring staff. Train and coach staff to perform effectively and efficiently.
Ensure timely resolution of CTM complaints in accordance with CMS guidelines. Ensure CMS and Plan reporting is submitted in required formats and within required time frames.
Update member notices and other materials to reflect changes in program requirements or benefits and as requested/required by regulatory agencies. Ensure prior approval of all member materials by appropriate regulatory entity.
REQUIRED QUALIFICATIONS:
Bachelor’s degree or 5 or more years’ relevant experience in Medicare Advantage
5 years’ experience in managed care/health care customer service and/or appeals and grievances
2-4 years’ experience in a supervisory position
Strong organizational and problem solving skills, excellent written and verbal communication skills
Ability to manage difficult customers and complex service issues
Ability to manage different projects concurrently within stringent deadlines
Proficient in standard office software (Word, Excel, PowerPoint, Access)
Sufficient information system skills to learn effective utilization of all VIVA HEALTH systems
Ability to articulate reporting requirements and system requirements to information systems staff
Viva Health, Inc. is a health maintenance organization providing quality, accessible health care. Viva Health Administration, L.L.C., is its sister company offering third party administration (TPA) services. Managed by professionals with years in the health care industry, Viva Health is also part of the renowned University of Alabama at Birmingham (UAB) Health System. All individuals and organizations connected with Viva Health work hard to simplify and improve health care through a network that includes many of the most respected physicians and hospital providers in the market.