Appeal Resolution Supervisor supervises a team responsible for the processing of appeals. Assigns and prioritizes cases. Being an Appeal Resolution Supervisor responds to and resolves escalated issues. Coaches and trains team in the utilization of industry standards and best practices. Additionally, Appeal Resolution Supervisor requires a bachelor's degree. Typically reports to a manager. The Appeal Resolution Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. To be an Appeal Resolution Supervisor typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision. (Copyright 2024 Salary.com)
The main function is to audit delegated and non-delegated professional, and facility claims for accurate processing per contract, health plan guidelines, State and Federal regulations within payment compliance time limits. This position will also be responsible for analyzing data, presenting data, and processing claims, if applicable.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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