Founded in 1978,Â Universal Health Services, Inc. (UHS)* is one of the nationâ€™s largest and most respected healthcare management companies, operating through its subsidiariesâ€"acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHSâ€™s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHSâ€™s well-reputed franchise with itsÂ customaryÂ exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortuneâ€™s Most Admired Companies. UHSâ€™s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care.Â
Prominence Health Plan, established in Reno in 1993 as St. Maryâ€™s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies.Â In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.Â We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.
Job Summary: Under the direction of the Supervisor, Appeals and Grievanceâ€™s, the Medicare Appeals/Resolution Specialist is accountable for the ensuring comprehensive review, processing, research and resolution of appeals and grievances submitted by both members and providers. This position is accountable for inquiries and to provide accurate and appropriate information and resolution in accordance with the Division of Insurance and the Centers for Medicare and Medicaid Services (CMS). Additional responsibilities include but are not limited to benefit and claim issues, eligibility, authorizations and customer service inquiries. This position is responsible for resolution including but not limited to assisting with escalated issues by providing research and follow up to the involved parties. Additional responsibilities include assuming responsibility of the Department in the absence of the Department manager/supervisor.