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Appeals and Grievances Analyst
Job Summary
A company is looking for an Appeals and Grievances Analyst.
Key Responsibilities:
- Process Appeals and Grievances by evaluating initial decisions against CMS guidelines and enrollee benefits
- Prepare detailed summary statements and research to substantiate appeal or grievance cases
- Ensure timely completion of Appeals and Grievances by coordinating reviewer assignments and moving cases through each review level
Required Qualifications:
- Bachelor's degree in business administration, Economics, Health Care, Information Systems, Statistics, or related fields
- Experience in a grievance and appeals environment, including knowledge of CMS regulations
- Experience in medical benefits and health care industry regulations and processes
- Experience with Medicare Advantage plans and CMS regulations regarding appeals and grievance processes
- Strong analytical, organizational, planning, and problem-solving skills
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COMPLETE JOB DESCRIPTION
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