Medicaid Appeals Specialist

Job Summary

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

Key Responsibilities

• Facilitates research and resolution of appeals, grievances, and complaints from members and providers
• Requests and reviews medical records and documents to determine appropriate responses
• Prepares appeal summaries and correspondence, ensuring compliance with regulatory requirements

Required Qualifications

• At least 2 years of managed care experience in a relevant environment
• Experience with health claims processing and knowledge of Medicaid and Medicare guidelines
• Customer service experience
• Strong organizational and time management skills
• Proficiency in Microsoft Office suite or applicable software