Medicare Appeals Specialist

Job Summary

A company is looking for a Specialist in Appeals & Grievances with Provider/Medicare experience.

Key Responsibilities

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

Required Qualifications

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