Appeals and Grievances Specialist
Virtual Vocations Inc, New York, NY, United States
A company is looking for a Specialist, Appeals & Grievances with Member Medicaid/Marketplace experience.
Key Responsibilities
Facilitates research and resolution of appeals, disputes, grievances, and complaints from members and providers Requests and reviews medical records and formulates conclusions to determine appropriate responses Prepares appeal summaries and correspondence while ensuring compliance with regulatory requirements
Required Qualifications
At least 2 years of managed care experience in a call center, appeals, and/or claims environment Health claims processing experience, including coordination of benefits and eligibility criteria Experience with Medicaid and Medicare claims denials and appeals processing Customer service experience Proficiency in Microsoft Office suite or applicable software programs
Facilitates research and resolution of appeals, disputes, grievances, and complaints from members and providers Requests and reviews medical records and formulates conclusions to determine appropriate responses Prepares appeal summaries and correspondence while ensuring compliance with regulatory requirements
Required Qualifications
At least 2 years of managed care experience in a call center, appeals, and/or claims environment Health claims processing experience, including coordination of benefits and eligibility criteria Experience with Medicaid and Medicare claims denials and appeals processing Customer service experience Proficiency in Microsoft Office suite or applicable software programs