Your Journey with us began the moment you made the choice to seek a career with Banner Health. Whether you are just beginning your career or your Journey has spanned 30 years, Banner's employer commitment is: "We'll help make a difference in your life and career so you can make a difference in the lives of others."
The Grievance and Appeals Program Manager serves as a key personnel for managing the day to day operations, compliance oversight for timeliness and support of staff. This position will be focused on grievances and appeals for AHCCCS and CMS. The Grievance and Appeals Program Manager will be able to work remotely following a in office training and will be required to come into to the office for on going trainings and meetings.
Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY This position is responsible for assisting with ensuring ongoing compliance and operational performance of new and extant Medicaid, Medicare and Commercial programs and projects. Works both independently and collaboratively with all health plan functional areas with the purpose to support the development, implementation, maintenance, monitoring, and continuous improvement of the Medicaid, Medicare and Commercial lines of business. Must possess advanced organizational and matrixed management skills to manage the highly complex ongoing and periodic processes including but not limited to the dissemination and verification of the implementation of regulatory and sub-regulatory guidance and rule changes issued by the products' regulatory authorities, filing various documents, forms and responses to each regulatory authority and management of many periodic processes including but not limited to Medicaid, Medicare and Commercial program bid submission, periodic Service Area Expansions, MA and HIX Call letter implementation, annual readiness review attestation, and Commercial product and rate development. This position may be responsible for supervising and directing Medicaid, Medicare and Commercial Programs that provides the clerical and technical support for the Health Plans.
CORE FUNCTIONS 1. Ensures all Medicaid, Medicare, MA and Commercial (both on and off the exchange) regulatory, sub-regulatory and policy guidance are disseminated in a timely manner and that such guidance is strictly adhered to, implemented and monitored and that evidence of implementation is verified and documented.
2. Manages the annual Medicaid, Medicare, and MA Bid process and periodic Commercial product and rate development. Manages the Service Area and Market Expansion process as necessary.
3. Manages or oversees the submission of all required materials and forms (i.e. Formulary Submission, annual website updates, marketing materials, Low Income Subsidy (LIS) match rates, monthly encounter data and Part C and D reporting, Policies, Evidence of Coverage) and data to the regulatory body overseeing a particular line of business.
4. Manages the development of the New Member Notifications. Assists Marketing with the production of all member materials for the Medicaid, Medicare and Commercial lines of business. Assists all functional areas with ensuring they are using the most current model member communications.
5. Attends all relevant AHCCCS, CMS, ADOI and CCIIO user group calls and meetings.
6. Assists with researching and tracking the Medicaid, Medicare and Commercial legislative environment and initiatives in collaboration with Legislative Affairs. Ensures the regulatory reporting requirements for the Medicaid, Medicare and Commercial lines of business are timely, accurate and compliant.
7. Manages the production of the Monthly Operational Dashboard. Ensures functional areas are compiling and reporting the data that comprise the Monthly Medicare Compliance Dashboard.
8. Collaborates with Network Development to ensure Medicaid, Medicare and Commercial Provider contracts meet regulatory requirements.
9. Provides process/program management and coordination to Health Plan teams/workgroups. Includes partnering with project and clinical leaders across the organization. Requires interactions with all levels of staff, management and physicians.
Must possess a knowledge as normally obtained through the completion of a Bachelor's degree in health care administration, finance administration or project management or equivalent combination of work experience.
This position requires the skills, knowledge and abilities typically acquired over one year of related experience and education. The work requires a high degree of organization, the ability to manage time and resources effectively, and the self-starter ability to work independently to achieve goals. Effective customer service and interpersonal relations skills are necessary. The ability to communicate effectively verbally, in writing and through common computer software is required.
Health Plan and Case Management experience and prior experience working in Medicaid and/or Medicare health plans preferred
Additional related education and/or experience preferred.
DATE APPROVED 11/19/2017
Internal Number: R8257
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.