Henry Ford Health · 1 day ago
Appeal & Grievance Ops Analyst (Hybrid - Troy/MI) - Health Alliance Plan
Troy, Michigan
Full-time
Hybrid
Entry, Mid Level
2+ years expHenry Ford Health is seeking an Appeal & Grievance Ops Analyst for their Health Alliance Plan division. This role involves analyzing and assigning appeals, grievances, and complaints while ensuring compliance with regulatory guidelines and providing administrative support to the A&G team.
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Responsibilities
Ensures daily case receipt via mail, fax, email, Customer Message Center and HAP’s documentation application Pega (Customer Services Specialists), and vendor sites. Responsible for investigation, assignment and tracking for Appeals, Reconsiderations, Redeterminations, and Grievances and entry into care management system. Ensures adherence to CMS, NCQA, and DOL regulatory and compliance guidelines
Assists Appeal and Grievance Analyst in providing case data to support all internal and external reporting. Maintains the Access database as the source for departmental information to support Data Validation, NCQA, Medicare 5 Star, MARS and other initiatives
Responsible for providing all case documentation for External Review requests by DIFS, OPM, MAXIMUS, etc
Works with leadership to create and update Correspondences for Medicare Advantage and Commercial members and providers while ensuring compliance with regulatory entities
Works with Client Services Training department to create and maintain updated documents and desk level procedures to ensure new and current staff have resources available for continuing education
Provides administrative support to the Appeal and Grievance Manager and the Appeal and Grievance Analyst. Maintains professionalism and confidentiality and orders departmental supplies. Organizes and oversees the annual case purge performed by the Clerical team
Ensures meetings are scheduled as required and proper materials are prepared, distributed and presented as all meetings including but not limited to departmental, Grievance Pre Hearing and Grievance Committee Hearings
Performs record and document searches, collection and submission for the Legal Department
Creates statistical weekly, monthly and annual reports for Appeals and Grievances activity providing rationale when the activities are skewed; compile annual reporting data using charts and MS Power Point for distribution to internal leadership
Establishes and maintain strong relationships and contacts across departments in addition to external contacts to ensure open communication, team effort and positive work relations. Continues to self-educate on changes in policies and procedures that occur in other departments that could have an impact on the Appeal and Grievance department operations and the servicing of member/customers
Performs other related duties as assigned
Qualification
Required
Associates Degree in Health Care, Business or related field required or 48 credit hours towards degree or an additional four (4) years of relevant and related experience may be considered in lieu of degree
Minimum of two (2) years of customer service experience in an office setting/call center
Demonstrated proficient use and knowledge of various software programs, such as Windows, Microsoft Word, Microsoft Excel, and Access
Mail screening required for all lines of business with emphasis on contracted and noncontracted provider appeals that include knowledge of medical appeals, claims investigation and denial reasons within the claims payment system
Preferred
Minimum of two (2) years of business office experience in health care preferred
Minimum of 2 years' experience reviewing and processing the intake of appeals, grievances, and claims inquiries
Company
Henry Ford Health
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10001+ employees
H1B Sponsorship
Henry Ford Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (212)
2024 (156)
2023 (134)
2022 (159)
2021 (140)
2020 (153)
Funding
Current Stage
Late StageTotal Funding
$40.27MKey Investors
Mort Harris
2020-06-04Grant· $0.27M
2018-04-09Grant· $20M
2016-12-05Grant· $20M
Leadership Team
Robert Riney
President and CEO
Brenda Craig
Vice President, Integrated Communications
Recent News
2025-11-07
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