Medicare Grievances Coordinator

Job Summary

To ensure effective resolution of member grievances and appeals, the full-time remote Medicare Grievances Coordinator will track and manage grievances, appeals, and IRE requests for Medicare and SNP product lines while adhering to regulatory guidelines.

Key responsibilities:

• Investigate and respond to member complaints, grievances, and provider appeals in writing according to department standards
• Utilize internal and external Health Plan contacts to facilitate the grievance process
• Organize tasks within regulatory requirements and deadlines while preparing Independent Review Entity case files

Required qualifications:

• Associate degree or equivalent professional work experience
• 1 year of experience in a health care environment
• Preferred background in medical claims and/or customer service
• Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology
• Experience with Medicare and SNP preferred