Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a Vendor Specialist:
This position requires advanced knowledge of all lines of business for MHP including Medicare, Commercial and National Committee for Quality Assurance (NCQA), URAC or general accreditation requirements to collaboratively work with other MHP departments. This position will coordinate MHP's denial notification process and maintain accurate and timely tracking and reporting in accordance with federal and state laws and department policies.
Coordinate and process all denial determinations
Track all denial data components as required by MHP and regulatory and accrediting agencies
Regularly provide written reports of compliance with denial notification standards
Conduct monthly internal audits of denial process to assure compliance with staff time frame standards and report results to manager
Draft denial letter templates
Identify and implement process improvement opportunities
Function as a liaison between the Utilization Management - MeridianCare department and the Member Services Case Specialists
Document user requirements for MCS systems development
Analyze the data elements of denial reports
Draft and update policies and procedures pertaining to the denial process
Remain updated on all relevant policy changes made by MHP
Remain updated on all relevant regulatory and accreditation reporting requirements and policy changes
May be required to work weekends, holidays and/or observed holidays as requested by leadership
What you can bring to Meridian:
Associate's degree is required
Bachelor's degree or Fellow designation from the Academy of Healthcare Management (AHM) is preferred
A minimum of one to two years experience as a Utilization Management Specialist or one to two years of related health industry experience is required
Knowledge of managed care and Michigan Medicaid guidelines
Thorough knowledge of the authorization process
Understanding of NCQA, URAC, CMS or general accreditation requirements for Utilization Management
Excellent verbal and written communication skills
Basic computer skills
Telephone service skills
Ability to be patient and courteous to all members and providers in all situations
Ability to work in teams
Successful completion of the Online Medicaid/Medicare Managed Care Course
What Meridian can offer you:
Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
Opportunity to work with the industry's leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
Meridian offers 401k matching that is above the national average.
Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor's or Master's degrees.
Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Equal Opportunity Employer