Team Leader – Appeals

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Supervise personnel involved in processing appeals, resolving coding disputes, handling grievances, and making coverage/organization determinations.

• Manage daily operations, assign case loads, and set team priorities.

• Ensure that resolutions adhere to organizational policies, as well as state and federal regulations and accreditation requirements.

• Prepare documentation for Appeals Committee and panel meetings.

• Address or direct challenging customer inquiries related to appeals, coding disputes, grievances, or quality concerns.

• Create and implement efficient workflows and processes in collaboration with staff.

• Provide guidance and instruction to staff regarding operational objectives, policies, and communications directed at providers and members.

• Assess data requests and confirm that data requirements are satisfied.

• Assist staff and management with information-related needs.

• Execute ad hoc reporting and oversee assigned projects/interventions.

• Enhance operations, address inter-departmental issues, and manage resource allocation across various departments and divisions.

⛳️ Requirements

• A Bachelor’s degree or an advanced degree (if required), or 7+ years of experience in a relevant field in place of a degree.

• At least 5 years of experience in a related area.

• Familiarity with appeals, coding disputes, grievances, coverage/organization determinations, and regulatory/accreditation guidelines.

• Experience in Case Management Supervision.

• Proficiency in Department Management.

• Skill in Employee Supervision.

• Understanding of Healthcare Management.

• Knowledge of Information Management.

• Strong Leadership capabilities.

• Experience in Managed Care.

• Mentorship skills.

• Expertise in Operational Process Improvements.

• Ability to organize effectively.

• Understanding of Patient Care.

• Proficient in People Management.

• Competence in Policy Management.

• Experience in Project Management.

• Skills in Resource Allocation Management.

• Proficiency in Resource Management.

• Experience in Supervision.

• Strong Team Management skills.

• Knowledge of Utilization Management.

🏝️ Benefits

• Annual Incentive Bonus based on corporate goal achievement and individual performance.

• 401(k) plan with employer matching.

• Paid Time Off (PTO).

• Competitive health benefits.

• Wellness programs.

• Comprehensive Total Rewards package.