Medicare Appeals Specialist

A company is looking for a Full-Time, Temporary Appeals and Grievances Specialist.

Key Responsibilities

Make independent decisions on Member Appeals impacting overall performance and CMS scoring

Serve as a liaison to the IRE and prepare and file Member IRE cases

Coordinate and prepare submissions for ALJ, MAC, and Medicaid Fair Hearings

Required Qualifications

Associate degree from an accredited institution required; Bachelor's degree preferred

Five years of related Medicare / Medicaid HMO Appeals and Grievance experience preferred

Proficient in MS Office with strong computer and keyboarding skills

Ability to read and interpret documents and calculate figures

Experience in customer service roles