Medicare Claims Appeals Specialist - Vista California

Company: VirtualVocations
Location: Vista, California
Posted On: 11/07/2024

A company is looking for a Medicare Claims Appeals and Grievances Specialist to review and resolve member and provider complaints.
Key Responsibilities

Research and resolve appeals, disputes, grievances, and complaints from members and providers
Request and review medical records and formulate conclusions in accordance with regulatory guidelines
Prepare appeal summaries and written responses to provider reconsideration requests related to claims payment

Required Qualifications

High School Diploma or equivalency
Minimum 2 years of operational managed care experience
Health claims processing background, including coordination of benefits and eligibility criteria
Familiarity with Medicaid and Medicare claims denials and appeals processing More...

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