Director of Appeals and Grievances

Job Summary

A company is looking for a Director, Appeals & Grievances.

Key Responsibilities

• Lead and direct the Grievance and Appeals Unit to review and resolve member complaints
• Provide oversight and training for provider dispute and appeals units to ensure compliance with Medicare standards
• Analyze grievance and appeals data to identify trends and recommend process improvements

Required Qualifications

• Associate's Degree or 4 years of Medicare grievance and appeals experience
• 7 years of experience in healthcare claims review and member appeals processing, including 2 years in a managerial role
• Experience with various medical claims types, including HCFA 1500 and UB92
• 2 years of supervisory/management experience in a managed care setting