Appeals and Grievances Specialist

A company is looking for a Specialist, Appeals & Grievances.

Key Responsibilities

Research and resolve Provider No Surprises Act cases in compliance with CMS standards

Request and review medical records and bills to determine claims outcomes

Prepare correspondence and document findings related to Provider No Surprise Act cases

Required Qualifications

At least 2 years of managed care experience in a relevant environment

Experience in health claims processing and knowledge of Medicaid and Medicare regulations

Customer service experience

Strong organizational and time management skills

Proficiency in Microsoft Office suite or applicable software