Appeals Clinical Consultant

Point32Health; Boston (MA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement plans

Life and disability insurance

Job summary

Point32Health is seeking a motivated professional to support Appeals & Grievances activities within a managed care setting. The role focuses on providing clinical resources for various aspects of Appeals & Grievances work, supporting training, and assisting analysts in understanding medical terminology and the provider plan of care relative to appeals.

Ideal candidates will have a grasp of commercial plans and Medicaid, and will contribute to ongoing process improvements.

Qualifications

• Understanding of Appeals & Grievances processes in managed care environment.
• Experience with commercial plans and Medicaid is preferred.
• Clinical aspects of A&G work familiarity helpful.

Responsibilities

• Provide support to Analyst team in developing knowledge and understanding of medical terminology and provider plan of care relative to appeal.
• Assist department trainer with new hire training as it relates to clinical aspects of A&G work
• Other duties and projects as assigned.

Skills

Appeals & Grievances knowledge

Medical terminology understanding

Job description

Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. The position requires a highly motivated individual with an understanding of Appeals & Grievances processes, particularly in the managed care environment with a focus Commercial plans and Medicaid. Serves as key clinical resource for various aspects of Appeal & Grievances work

• Provide support to Analyst team in developing knowledge and understanding of medical terminology and provider plan of care relative to appeal.
• Assist department trainer with new hire training as it relates to clinical aspects of A&G work
• Other duties and projects as assigned.
• the skills, education, training, credentials, and experience of the candidate; as well as internal equity. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Employer-paid life and disability insurance with additional buy-up coverage options
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.