Project Coordinator (Medicare Advantage Appeals)
Requisition #: 413663
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time
Weekend Work Required: Yes
Date Posted: Oct. 7, 2021
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.
This can be a virtual work position depending on the State of residence. Must reside in one of the following to be considered: MD, VA, FL, PA, DE or District of Columbia.
The Project Coordinator position is responsible for providing support to the department under minimal supervision. Coordinates multiple aspects of new and existing initiatives. The position will also assist in routine and complex daily activities and inquiries. Responsible for investigation, analysis of requests or arbitrations from inside and outside the organization. Assists in development, implementation and monitoring of regulatory compliance accreditation and administrative functions. May work on projects requiring extensive research and tracking. This position is a resource for the department that manages work flow and efficiency.
This position will report to the Appeals Director and will be responsible for administrative and clerical duties in preparation and execution of JHHC’s Medicare Advantage Appeals. The ideal candidate will be comfortable working in a production environment with strict, federally regulated timeframes; familiar with the Centers for Medicare & Medicaid Services’ Medicare Advantage program and the Medicare Advantage appeal process; and experienced in submitting Medicare Advantage Appeals to MAXIMUS Federal Services, CMS’ Independent Review Entity. Duties may include reviewing received appeals for completion; corresponding with members and/or providers to secure necessary documentation; compiling relevant case information for review; follow-up with internal partners or external reviewers; completing MAXIMUS’ Reconsideration Background Data form and assembling MAXIMUS submission packets; and managing workloads to meet firm timelines.
- Associate's degree in business, management or related discipline required. Equivalent related work experience may be substituted for some educational requirements.
Managed care organization (MCO) experience preferred.
- Proficient PC word processing, spreadsheet, and presentation software skills as well as aptitude for learning and mastering new computer applications
- Excellent communication skills, both oral and written, to effectively communicate will all levels of staff and business related associates is required.
- Demonstrated ability to work under pressure at times while remaining flexible, proactive, resourceful and efficient with a high level of professionalism and confidentiality. Demonstrated ability to exercise good judgment in handling sensitive and confidential information and situations. Analytical ability to interpret data and policies.
- Demonstrated excellence in prior leadership role/s
- Demonstrated organizational, interpersonal, written and verbal communication skills required
- Ability to prioritize work and analyze workflows
- Ability to work independently and in groups
- MS Office (Word and Excel) experience a plus
- Must be able to work independently and as part of a team
- Must have good organization skills and be able to prioritize
- Must excel at motivation, coaching and counseling others
Required Licensure, Certification, Etc.:
- Three (3) or more years of experience in health plan operations setting required, preferably in Appeals & Grievances, Claims, Compliance, or Customer Service
- Two (2) or more years of Medicare Advantage experience preferred
- Prior experience in Member Appeals or familiarity with Medicare Advantage Appeal guidance (“Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance”) strongly preferred
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
Johns Hopkins Medicine.