Senior Appeals Manager, Healthcare Payer Operations

Universal Health Services; Reno (NV); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Generous Paid Time Off

Excellent Medical, Dental, Vision and

Prescription Drug Plans

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health, part of Universal Health Services, is seeking a Manager, Appeals to oversee the health plan's Appeals Department across Commercial, Self-Funded, and Medicare Advantage lines. You will ensure timely, accurate, and compliant adjudication of all appeals in line with CMS and state regulations, contracts, and organizational policies.

You will develop strategies to improve outcomes, audit readiness, and member/provider satisfaction, collaborating with Medical Directors, Utilization

Qualifications

• Minimum 5 years in healthcare payer operations or related field.
• Proven leadership in appeals, grievances, utilization management, or claims.
• Experience with Medicare Advantage, Commercial, and Self-Funded plans preferred.

Responsibilities

• Oversee Appeals Department operations and ensure regulatory compliance.
• Lead strategy to improve appeal outcomes and audit readiness.
• Collaborate with Medical Directors, Utilization Management, Claims Ops, Compliance, Legal, and Customer Service.

Skills

Leadership

Regulatory compliance

Data analysis

Communication

Project management

Education

BS in health administration or related field

Tools

Kronos

Microsoft Office

CMS tools

Job description

Prominence Health, part of Universal Health Services, is seeking a Manager, Appeals to oversee the health plan's Appeals Department across Commercial, Self-Funded, and Medicare Advantage lines. You will ensure timely, accurate, and compliant adjudication of all appeals in line with CMS and state regulations, contracts, and organizational policies.

You will develop strategies to improve outcomes, audit readiness, and member/provider satisfaction, collaborating with Medical Directors, Utilization