Medicare Appeals Operations Expert

Job Summary

A company is looking for an Appeals and Grievances Operations Expert.

Key Responsibilities

• Oversee production, accuracy, and timely delivery of appeals and grievances operational reports
• Analyze appeals data to identify trends and operational bottlenecks, presenting findings to leadership
• Collaborate with cross-functional teams to enhance workflows and improve operational efficiency

Required Qualifications

• Bachelor's degree in healthcare administration, nursing, business, or related field, or equivalent work experience
• 5+ years' experience in Medicare Advantage plans, with at least 3 years in appeals & grievances
• In-depth knowledge of CMS regulations and Medicare Managed Care Manual
• Expert-level understanding of Medicare Advantage appeals and grievance requirements