ATHENA CONSULTING JOB LISTINGS
Behavioral Health Quality Appeals Specialist
We are currently hiring for the
Maryland Behavioral Health Administrative Services Project!
ATHENA Consulting is an award-winning staffing firm serving state and local governments. Our mission is to make lives better! We make our Clients’ Lives Easier by engaging and supporting our clients and partnering with them to be the most knowledgeable staffing partner. We make our Employees’ Lives Better by identifying and cultivating their talents and matching these talents with our customers’ needs. ATHENA places a high value on customer service, accountability and getting the job done.
POSITION SUMMARY:
This FULL-TIME position ranges from $21.00-$23.00 per hour depending on experience and is located in Hanover, Maryland. The Behavioral Health Quality Appeals Specialist is responsible for coordinating the quality review of denial and appeal notifications and system documentation, supporting initiatives in accordance with state, contract, and accreditation requirements, and related duties as assigned.
This position is Hybrid and is required to go into a Carelon Pulse Point Center 1 day a week.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- Monitors and evaluates clinical appeal documentation created by and for frontline staff, including reviewing, researching, and investigating all types of clinical appeals.
- Generates ideas for performance improvement, increases member satisfaction, and improves internal policies and procedures.
- Generates and conducts training opportunities to improve the overall clinical appeal process.
- Investigates non-standard requests and problems to provide assistance to frontline staff and internal QA teams.
- Prepares, analyzes, and submits monthly, quarterly, and annual Quality reports.
- Coordinates contract compliance audits, including developing audit tools, incorporating state corrective actions, participating in onsite audits, compiling audit results, preparing follow-up letters, tracking submission of corrective actions, and summarizing overall results.
- Collaborates with Directors and Business Analysts to develop quality management measures, including gathering data requirements, analyzing and verifying data, preparing final reports, and presenting findings to teams, committees, and the Governing Board, as needed.
- Develops and presents training materials, generates committee agendas, guides focus groups, and facilitates project team and committee meetings.
- Coordinates with internal departments and prepares documents for external Quality review, as well as URAC and NCQA site visits.
- Coordinates data collection for quality activities and studies, and completes annual updates of quality policies and procedures.
Required Skills/Abilities:
- Strong crisis intervention and assessment skills.
- Excellent verbal, written, and listening communication skills within the English language.
- Proven, high quality customer service (internal and external customers).
- Ability to work collaboratively.
- Solid ability to analyze situations carefully and adopt appropriate courses of action.
- Ability to understand and adhere to the duties, methods, and procedures required by the position.
- Excellent organizational skills and attention to detail.
- Ability to prioritize tasks.
- Ability to effectively communicate to large and small group audiences.
- Proficient with Microsoft Office Suite or related software.
Education and Experience:
- Bachelor’s degree required
- 2 years of experience in quality assurance, quality management, managed care, and/or healthcare preferred
- Travels to worksites and other locations as necessary.
- A writing sample will be required if chosen to interview.
Physical Requirements:
- Possible prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift and move up to 25 pounds at times.
- Standard hours of work TBD.
- Travel may be required up to 25% of the time.
Successful ATHENA employees will display the following characteristics:
- You strive to be the best in your field currently and in the future.
- You like to make your employer look good.
- You find solutions, where others only see problems.
- You are proactive, you make and meet commitments, and you perform your duties exceedingly well.
- You are aware of the employer’s needs at all times and are well-versed in what you personally and ATHENA can offer them as a whole.
- You have the ability to work with diverse, integrated, deliverable-driven teams to accomplish the larger mission.
The benefits of working for ATHENA include a full Benefit package:
- Support from a team of professionals committed to making your life better.
- 19 days of PTO.
- 12 paid holidays, 13 paid holidays during election years.
- Merit / COLA increases.
- Flex time allowed, during the same week.
- Medical, dental and vision insurance.
- Medical and dependent flexible spending account.
- Pet insurance.
- Mass transportation benefit for the Maryland and Washington, D.C. area.
- 401k with a generous employer match.
- Easy to use employee self-serve HR portal.
The statements in this Job Posting are intended to describe the general nature and minimum level of work required. The content should not be construed as a complete list of all duties, responsibilities, and skills required to meet the criteria for this position. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Application for employment is not intended to and does not create a contract or offer of employment and if hired, employment with the company is on an at-will basis and could be terminated at the will of either party.
ATHENA Consulting LLC does not discriminate in hiring based on federally protected classifications to include but not limited to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, marital status or other characteristics protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
