About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Appeals Specialist, Hybrid, MI Residency Required
We are looking for an Appeals Specialist to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/
Position Summary:
Responsible for assisting with coordination of all appeal/grievance activity for the Plan. Responsible for ensuring departmental compliance with applicable regulations and tracking appeal and grievance activity, complying with state and regulatory standards. Assists in preparing and researching case files as necessary. Responsible for research and resolution of member and provider claims issues. Responsible for assisting with member and provider education opportunities regarding complaints/grievances/appeals. Identifies process improvement opportunities and develops plans to address opportunities.
This position requires the employee to come onsite as requested by the leader to Flint, MI.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
#LI-AK1
Qualifications:
Required:
- High School Diploma or equivalent (GED).
- One (1) year experience in healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.
Preferred:
- Associate degree in business, health care or related field.
- Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, regulatory compliance, claims processing, membership/eligibility).
- Two (2) years healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
