nTech Workforce
Appeals and Grievances Specialist
nTech Workforce - Reston, Virginia, United States, 22090
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Overview
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Overview
Terms of Employment:
W2, Contract, 2-months with the possibility of extension
This position is remote, but candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas.
Overview and Key Responsibilities: Are you an experienced Appeals and Grievances professional with a strong background in government programs? Join our client’s Government Programs Appeals and Grievances (A&G) team as an Appeal Specialist II! This is a critical role where you'll help stabilize a dynamic team by hitting the ground running and managing the full lifecycle of A&G cases, from intake to investigation and closure. If you have non-negotiable experience with both Appeals and Grievances processes and the Guiding Care system, and are ready to make an immediate impact, we encourage you to apply! Key responsibilities include: Manage the full gamut of Appeals and Grievances processes, including intake, case investigation, and closing cases. Utilize the Guiding Care system as the primary tool for A&G intake, documentation, and letter generation. Pull information related to claims from TMG Facets (claims processing platform) to include in correspondence. Contribute to stabilizing and restructuring the A&G team.
Required Qualifications: Demonstrated experience in Appeals and Grievances (A&G) processes. Direct experience with the Guiding Care system. Strong preference for experience with government programs (Medicare, Medicaid, D-SNP) A&G. Commercial A&G experience is also considered. Ability to handle a variety of A&G tasks from start to finish. Detail oriented professional. Minimum of 3 years of relevant experience.
Preferred Qualifications: Familiarity with TMG Facets for pulling claims-related information.
Overview and Key Responsibilities: Are you an experienced Appeals and Grievances professional with a strong background in government programs? Join our client’s Government Programs Appeals and Grievances (A&G) team as an Appeal Specialist II! This is a critical role where you'll help stabilize a dynamic team by hitting the ground running and managing the full lifecycle of A&G cases, from intake to investigation and closure. If you have non-negotiable experience with both Appeals and Grievances processes and the Guiding Care system, and are ready to make an immediate impact, we encourage you to apply! Key responsibilities include: Manage the full gamut of Appeals and Grievances processes, including intake, case investigation, and closing cases. Utilize the Guiding Care system as the primary tool for A&G intake, documentation, and letter generation. Pull information related to claims from TMG Facets (claims processing platform) to include in correspondence. Contribute to stabilizing and restructuring the A&G team.
Required Qualifications: Demonstrated experience in Appeals and Grievances (A&G) processes. Direct experience with the Guiding Care system. Strong preference for experience with government programs (Medicare, Medicaid, D-SNP) A&G. Commercial A&G experience is also considered. Ability to handle a variety of A&G tasks from start to finish. Detail oriented professional. Minimum of 3 years of relevant experience.
Preferred Qualifications: Familiarity with TMG Facets for pulling claims-related information.