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340B Health

Appeals & Grievances Specialist

340B Health, Los Angeles, California, United States, 90079


Description

As the Appeal & Grievance Specialist, you will be responsible for:Managing the intake and resolution of member and provider appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid Services) regulations for Medicare Advantage plansEnsuring that all cases are processed within mandated timeframes and that clear, timely communication is provided to all stakeholdersWorking closely with the medical director and appeal & grievance team to ensure that all cases are handled effectivelyOther duties as assignedSalary Range: $31.45-$43.17/hourlyQualifications

We’re seeking a detail-oriented individual with:Bachelor’s degree in a healthcare related field or equivalent experience, preferred2 or more years of experience in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferredExperience in interpreting CMS guidelines and working with regulatory requirements, preferredStrong knowledge of Medicare Advantage plans, CMS regulations, and the appeals and grievances processExcellent verbal and written communication skillsAbility to handle sensitive and confidential information with discretionProficiency with case management software and Microsoft Office applications

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