Appeals and Grievances Auditor

Job Summary

A company is looking for an Appeals & Grievances QA Auditor.

Key Responsibilities

• Audit grievances and appeals for compliance with policies, procedures, and regulatory requirements
• Identify casework issues and provide feedback for corrections to colleagues
• Track audit findings and lead meetings to discuss trends and coaching opportunities

Required Qualifications, Training, and Education

• Bachelor's degree or equivalent business experience
• Minimum of 5 years of experience in Appeals and Grievances, including use of relevant software
• Prior experience with A&G Medicare processes
• Knowledge of Medicare Part B, C & D, HIPAA, and compliance regulations