Director, Appeals and Grievances Reporting at Healthfirst


Director, A&G Reporting

  • Telecommute
  • Full time
  • R008139

The Director, Appeals & Grievances (A&G) Reporting is a critical role in the successful delivery of departmental reporting, analytics and strategic objectives established by the Vice President of A&G. The incumbent delivers strong leadership and technical capability for the overall A&G organization. He/she will take a hands-on approach to execute reporting tasks and analytics as well as be a subject matter expert with Sequel and SQL related technologies. The Director, A&G Reporting is highly collaborative, agile and flexible and is able to respond to and ensure reporting targets, milestones and methods are achieved.

Duties & Responsibilities:

  • Responsible for the full inventory of reporting to include state. Federal, and other internal and external reports required monthly, quarterly, annually, or ad hoc.
  • Ensure all NY state and federal compliance, audit and regulatory reporting requirements are met
  • Communicates A&G results and collaborates with operations areas to identify resulting process improvements
  • Apply measures and controls that ensure the efficient and compliant operational management of A&G with emphasis on execution, outcomes, continual improvement and performance enhancement.
  • Determine best practices and strategically deploy approaches to performing Appeals & Grievances reporting, metrics and analysis.
  • Institute and manage working relationships within operations areas to identify and execute overall process improvements
  • Diagnose and understand operational challenges in addition to skill gaps to provide leadership and management to the Appeals & Grievances team
  • Drive the development of innovative reporting tools and processes to assist in overall handling of A&G functions
  • Keep abreast of industry trends to strategically ensure that department practices and procedures reflect industry and regulatory standards.
  • Additional duties as necessary or assigned

Minimum Qualifications:

  • Bachelor’s degree from an accredited institution or equivalent work experience in IT, healthcare/healthcare administration, business required
  • Must possess intermediate to advanced knowledge of SQL programming languages including various tools such as SQL Server Management Studio, dBeaver and/or Alteryx (or other SQL reporting engines).
  • Hand’s on experience with MS Excel with a deep understanding of formulas/functions
  • MS Access with proven ability to query and report via MS Access is required.
  • Demonstrates a working understanding of the CMS Medicare reporting requirements and/or NY DOH reporting (or other State Medicaid reporting)
  • Proven hands-on experience creating, delivering reports and analytics to various stakeholders up to and including VP and C-suite audiences
  • Demonstrated ability to work well with others, understand process flows and correlating platforms, recommend options and implement solutions
  • Planning, organization, and implementation skills- experience managing multiple concurrent priorities.

Preferred Qualifications:

  • MBA or master’s degree from an accredited institution in IT, healthcare/ healthcare administration, business or related field is preferred
  • Minimum of 5 years of relevant work experience in a Healthcare environment, Insurance Plan and Appeals function is preferred
  • Microsoft Open Database Connectivity (ODBC) experience is preferred
  • Experience with Amazon Web Services is preferred
  • Leadership experience managing a small team is preferred
  • Management experience in an operational department within the healthcare industry
  • In-depth knowledge of reporting and auditing standards, policies and procedures
  • Experience developing strategy and processes for a department or function

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

See all Healthcare Jobs >

Sign up for Daily Remote Job Alerts!

Want Access to 25,000+ More Remote and Flexible Jobs?

More Jobs

More Jobs

Part-time to full-time,
freelance to employee

More Career Fields

More Career Fields

50+ flexible
job categories

More Resources

More Resources

Q&A's, webinars,
career coaching & more

Learn More About Our Premium Service