Medicaid Appeals Specialist

Job Summary

Facilitating the resolution of member and provider complaints, the full-time Medicaid Appeals Specialist will manage appeals, grievances, and disputes while ensuring compliance with regulatory standards and internal timelines.

Key responsibilities

• Conduct comprehensive research to resolve appeals and grievances from members and providers
• Request and review medical records and claims documentation to determine appropriate outcomes
• Prepare appeal summaries and correspondence, ensuring compliance with regulatory requirements

Required qualifications

• At least 2 years of managed care experience in a call center, appeals, or claims environment
• Health claims processing experience, including coordination of benefits and eligibility criteria
• Experience with Medicaid and Medicare claims denials and appeals processing
• Strong organizational and time management skills
• Proficiency in Microsoft Office suite and applicable software programs