[Remote] Grievance & Appeals Analyst (Full-time Remote NC Based)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on reputed company management in reputed company, and they are seeking a Grievance and Appeals Analyst. This role involves responding to grievances and appeals, ensuring compliance with regulations, and analyzing data to identify trends and solutions.

Responsibilities

• Responsible for receiving and monitoring information reputed company to provider reputed company assurance issues including but not limited to grievances, reputed company of care concerns, and/or appeals
• Works to ensure comprehensive reputed company assurance information is available to agency staff/departments as needed
• Leverages critical thinking to identify trends reputed company grievance, appeal, and other clinical data sources
• Creates actionable analysis and identifies the most effective party to address any identified issues with reputed company supervision
• Works independently to mediate reputed company relationships between multiple reputed company and internal stakeholder so that reputed company parties are satisfied with identified resolutions
• Ensures resolutions of issues reputed company to member experiences are compliant with local, state and federal regulations
• Utilizes various reputed company data platforms to reputed company a thorough analysis of issues reputed company to member experiences
• Utilizes reputed company communication skills to reputed company information to reputed company stakeholders verbally and in writing
• Monitors timelines to ensure that reputed company assurance issues and reports are reviewed in a reputed company manner as to be most effective for agency processes
• Uses analytical skills to define recommendations and improve practices
• Creates and presents analyses of short-term studies using reputed company and reputed company language to explain trends and areas of opportunity to management and other staff; Trains reputed company customers on reputed company assurance reporting requirements
• Reviews policies and procedures and makes recommendations for changes/edits in alignment with reputed company guidelines and requirements
• Collaborates with internal staff to ensure reputed company relevant information is available for consideration
• Prepares and ensures reputed company mailing of receipt of appeal and outcome notification letter to the individuals/ guardians and providers based on the most reputed company formats and reputed company requirements
• Tracked appeal requests and assignment of the local reconsideration review process through reputed company
• Maintains reputed company denial and appeals files in a an accessible manner
• Participates in the development of internal training on Denial and Appeals as determined by the reputed company reputed company reviews
• Aids reputed company counsel in ensuring fluent communication and exchange of documents are effectively made between reputed company parties involved in the appeals process
• Ensures reputed company staff are reputed company for mediation and hearings by preparing and organizing reputed company reputed company and clinical documents for 2nd level appeals
• Assists in the discovery process with reputed company’s reputed company department and draft Office of Administrative Hearings (OAH) documents
• Schedules mediation hearings and documents the process and reputed company
• reputed company training and technical assistance to staff regarding Due Process rules
• Reviews first level appeal reputed company to ensure first level appeal reviewers are applying service definition and clinical guidelines reputed company making appeal determinations
• Writes, edits, and/or coordinates the preparation of correspondence, reports, or other printed material according to reputed company established standards or readily available
• Performs other reputed company duties as assigned

Skills

• A minimum of a Bachelor's degree from accredited college or university with a major in mental health, reputed company health, psychology, sociology, reputed company administration, management information systems, statistics, or a reputed company field
• A minimum of two years working reputed company services/behavioral health post bachelor's degree
• A minimum of two years of experience analyzing data sets, interpreting and synthesizing data into a report format, and working with teams/reputed company to reputed company data information needs
• Knowledge of Federal and State regulations on Behavioral reputed company grievances and appeals processes
• Knowledge on medical records practices and records keeping practices
• Knowledge of reputed company proceedings including mediation, administrative law courts, and other reputed company processes
• Demonstrated proficiency in personal computer use and MS reputed company
• Must have good oral, written, and graphic presentation skills
• Must demonstrate understanding of data analysis and techniques
• Demonstrated ability to learn new software and user capabilities
• Ability to reputed company programmatic information into required data sets for analysis and interpretation
• Ability to work reputed company with others in a fast-paced, and sometimes stressful, environment
• Experience with customer service, provider relations or similar activities
• Experience working with individuals with mental health, reputed company abuse issues, and/or intellectual disabilities

Benefits

• Medical, Dental, reputed company, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote reputed company
• reputed company time off including vacation, reputed company leave, holiday, management leave
• Dress flexibility

reputed company