Senior BPM Lead (Appeals & Grievances Supervisor)
- Taguig City, Metro Manila
- Permanent
- Full-time
- Monitor inventory and assign work to analysts
- Directly supervise staff in accordance with company policies
- Maintain oversight of casework to ensure Appeals and Grievances move through each review level without delay, and ensure all cases are processed timely to meet A&G SLAs
- Mentor analysts and assist with providing case guidance and direction as needed
- Participate with QA programs to implement and maintain continuous quality improvement
- Bring to management’s attention any system or process issues determined during the investigation of the appeal or grievance
- Drive operational excellence into all processes and departmental interactions based on CMS and requirements
- Demonstrate excellent working knowledge of Appeals and Grievance regulations and CMS guidance, and ability to convey this knowledge to analysts
- Develop and implement effective strategies that enables the department to maintain efficient and cost-effective processes
- Partner with other teams/departments to promote continuous feedback and quality improvement
- Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree
- At least 2 years of experience in a supervisory or management role within the Medicare healthcare industry (preferably Claims)
- At least 3-5 years of experience in a grievance and appeals environment
- In-depth knowledge of CMS Grievance and Appeals regulations
- Strong analytical, organizational, planning and problem-solving skills
- Ability to effectively interface with employees at all levels
- Ability to read and interpret policies and procedures
- Ability to work in a fast-paced environment and lead staff to success
- Strong focus to drive and serve the customer
- Claims processing or medical billing/coding experience an advantage