Medicare Appeals Operations Expert

Job Summary

A company is looking for an Appeals and Grievances Operations Expert.

Key Responsibilities

• Oversee production, accuracy, and timely delivery of appeals and grievances operational and regulatory reports
• Analyze appeals data to identify trends, operational bottlenecks, and training needs
• Support internal compliance requests by providing data/reports and subject matter expertise

Required Qualifications

• Bachelor's degree in healthcare administration, nursing, business, or related field, or equivalent work experience
• 5+ years of experience in Medicare Advantage plans, with at least 3 years in appeals and grievances
• In-depth knowledge of CMS regulations and Medicare Managed Care Manual
• Expert-level understanding of Medicare Advantage appeals and grievance requirements
• Proficiency with Microsoft Excel, PowerPoint, and appeals/case management systems