BayCare Health System
Grievance Specialist-Health Plan
BayCare Health System, Clearwater, Florida, United States, 34623
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Why BayCare?
At BayCare, we are one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence. Summary Manages intricate grievances, collaborating closely with healthcare providers and members to resolve disagreements, and ensuring adherence to regulatory requirements. Conduct thorough investigations by gathering relevant information, documentation, and medical records. Triage, plan, and execute intake of Appeals and Grievance submissions. Keeping track of deadlines, ensuring all necessary documentation is completed and filed appropriately, and communicating effectively with all parties involved. Provide reports on the status of grievances and provide updates to management. Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. Participate in internal quality assurance activities and contribute to the development of best practices for grievance and appeal resolution. Adhere to HIPAA requirements, guidance on documentation gathering including naming conventions and security protocols. Requires deep understanding of gap closure specifications. Knowledge of health plan operations, benefit coverage, and claims processing. Familiarity with regulatory requirements governing grievance and appeal processes, such as ERISA, HIPAA, and state-specific regulations. Proficiency in using computer systems and software for case management and documentation. Minimum Qualifications Required 3 years Customer Service (or similar) within a healthcare or insurance environment with HS/GED; Or - 1 year - Customer Service (or similar) within a healthcare or insurance environment with Associates. Facility:
BayCare Health System, Admin - Non Hospital Related-BHS Location:
Park Place Status:
Full Time, Exempt: No Shift Hours:
8:00 AM - 5:00 PM Weekend Work:
Occasional On Call:
No How often will this team member be working remotely?
Hybrid Equal Opportunity Employer Veterans/Disabled Seniority level
Not Applicable Employment type
Full-time Job function
Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at BayCare Health System by 2x Get notified about new Health Specialist jobs in
Clearwater, FL . Related roles
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At BayCare, we are one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence. Summary Manages intricate grievances, collaborating closely with healthcare providers and members to resolve disagreements, and ensuring adherence to regulatory requirements. Conduct thorough investigations by gathering relevant information, documentation, and medical records. Triage, plan, and execute intake of Appeals and Grievance submissions. Keeping track of deadlines, ensuring all necessary documentation is completed and filed appropriately, and communicating effectively with all parties involved. Provide reports on the status of grievances and provide updates to management. Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. Participate in internal quality assurance activities and contribute to the development of best practices for grievance and appeal resolution. Adhere to HIPAA requirements, guidance on documentation gathering including naming conventions and security protocols. Requires deep understanding of gap closure specifications. Knowledge of health plan operations, benefit coverage, and claims processing. Familiarity with regulatory requirements governing grievance and appeal processes, such as ERISA, HIPAA, and state-specific regulations. Proficiency in using computer systems and software for case management and documentation. Minimum Qualifications Required 3 years Customer Service (or similar) within a healthcare or insurance environment with HS/GED; Or - 1 year - Customer Service (or similar) within a healthcare or insurance environment with Associates. Facility:
BayCare Health System, Admin - Non Hospital Related-BHS Location:
Park Place Status:
Full Time, Exempt: No Shift Hours:
8:00 AM - 5:00 PM Weekend Work:
Occasional On Call:
No How often will this team member be working remotely?
Hybrid Equal Opportunity Employer Veterans/Disabled Seniority level
Not Applicable Employment type
Full-time Job function
Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at BayCare Health System by 2x Get notified about new Health Specialist jobs in
Clearwater, FL . Related roles
Health Information Specialist (ROI experience) Front Office Assistant - Radiation Oncology Clinic - Orlando Health Bayfront Cancer Institute Customer Service Specialist - Guest Services - Bayfront Health HEALTH SERVICES REPRESENTATIVE - 64029132 1 1 Field Clinical Specialist- Shockwave (Clearwater/ St Pete, FL) Clearwater, FL $73,000.00-$78,000.00 1 week ago Referral Coordinator Department of Health Front Office Assistant - Surgical Oncology - Orlando Health Bayfront Cancer Institute Health Info Mgmt Specialist Sr - Mease Countryside Clearwater, FL $52,000.00-$56,000.00 1 day ago Front Office Assistant - Surgical Oncology - Orlando Health Bayfront Cancer Institute Field Clinical Specialist- Shockwave (Clearwater/ St Pete, FL) Intensive Case Manager Department of Health Front Office Assistant - Surgical Oncology - Orlando Health Bayfront Cancer Institute Medical Front Office Coordinator-CW Countryside Field Clinical Specialist- Shockwave (Clearwater/ St Pete, FL) Care Transitions Coordinator Home Health Community Relations Specialist - Pinellas and Manatee Counties We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr