Job Information
Brighton Health Plan Solutions, LLC Appeals Manager in Westbury, New York
About The Role
The Appeals Manager is responsible managing Appeal Supervisors and identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Primary Responsibilities
Effectively manage Appeal Supervisors, providing full-time support to appeals, internal departments, vendors, and customers.
Demonstrate strong leadership and promote employee engagement.
Distribute daily work, monitor pending inventory, and ensure resolution of aged items.
Train new hires, vendors, and existing staff as required.
Research and respond to escalated issues.
Identify process improvement opportunities and establish supporting workflows.
Collaborate with Medical Management staff to handle appeals in a timely and efficient manner.
Review and process High Dollar claims and adjustments, ensuring accuracy.
Assist Customer Service in resolving customer inquiries and concerns.
Support the Client Services department by researching and resolving client inquiries.
Coach and counsel employees to exceed quality, appeals processing, claims accuracy, and productivity standards, removing obstacles to meet goals.
Perform audits as necessary.
Manage payroll, timesheets, schedules, and time off requests.
Address and document performance issues, conducting quarterly evaluations.
Consistently host individual and team meetings.
Essential Qualifications
Solid supervisory and leadership skills.
Advanced knowledge of Microsoft Word and Excel.
Strong knowledge of contracts, medical terminology, ERISA appeals and claims processing and procedures.
Advanced claims adjudication experience including facility, professional and ancillary claims.
Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
Problem solving/analysis.
Organizational skills; ability to effectively prioritize and multitask.
Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.
Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
Bachelor’s Degree preferred or comparable experience in the healthcare field.
About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
DEI Purpose Statement
At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
*We are an Equal Opportunity Employer
Annual Salary Range: $80,000 - $90,000
The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com
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