Medicare Appeals and Grievances Coordinator - Remote

Overview

The Medicare Appeals and Grievances Coordinator will manage and document member and provider appeals and grievances, ensuring timely resolution and compliance with contractual obligations.

In Short

• Coordinate and process appeals and grievances.
• Document and track all cases meticulously.
• Communicate effectively with members and stakeholders.
• Prepare reports for analysis and feedback.
• Resolve payment and claims processing issues.
• Work independently to assist members with their appeals.
• Ensure compliance with regulatory requirements.
• Participate in quarterly team meetings in Somerville, MA.
• Utilize technology for tracking and reporting.
• Contribute to system improvements to reduce appeals.

Requirements

• Bachelor's Degree or equivalent experience.
• 3-5 years of health plan experience preferred.
• Experience in Medicare appeals is highly preferred.
• Strong customer service skills.
• Excellent communication and organizational skills.
• Aptitude for technology-based solutions.
• Ability to manage multiple tasks effectively.
• Adaptability to changing priorities.
• Attention to detail and accuracy in documentation.
• Ability to work independently.

Benefits

• Comprehensive benefits package.
• Career advancement opportunities.
• Recognition programs for contributions.
• Competitive base pay.
• Potential for differentials and bonuses.
• Support for professional growth.
• Flexible work environment.
• Quarterly team meetings for collaboration.
• Inclusive workplace culture.
• Commitment to community service.