Medicaid Appeals Specialist

Job Summary

A company is looking for a Specialist, Appeals & Grievances with Medicaid experience.

Key Responsibilities

• Review and resolve member and provider complaints in accordance with Medicaid standards
• Conduct comprehensive research on appeals, grievances, and complaints to ensure compliance with timelines
• Prepare appeal summaries and correspondence, ensuring accuracy and adherence to regulatory requirements

Required Qualifications

• High School Diploma or equivalency
• Minimum 2 years of operational managed care experience
• Health claims processing background, including coordination of benefits and eligibility criteria
• Familiarity with Medicaid claims denials and appeals processing