Medicare Claims Appeals Specialist
Company: VirtualVocations
Location: Vista
Posted on: November 6, 2024
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Job Description:
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
Keywords: VirtualVocations, La Mirada , Medicare Claims Appeals Specialist, Other , Vista, California
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