Appeals & Grievances Specialist

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 plans
• Ensuring that all cases are processed within mandated timeframes and that clear, timely communication is provided to all stakeholders
• Working closely with medical director and appeal & grievance team to ensure that all cases are handled effectively
• Other duties as assigned

Salary Range: $31.45-$43.17/hourly Qualifications

We're seeking a detail-oriented individual with:

*Bachelor's degree in a healthcare related field or equivalent experience, preferred

*2 or more years of experience in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred

*Experience in interpreting CMS guidelines and working with regulatory requirements, preferred

*Strong knowledge of Medicare Advantage plans, CMS regulations, and the appeals and grievances process

*Excellent verbal and written communication skills

*Ability to handle sensitive and confidential information with discretion

*Proficiency with case management software and Microsoft Office applications