Appeals and Grievances Specialist
Company: VirtualVocations
Location: Amarillo
Posted on: October 16, 2024
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Job Description:
A company is looking for a Specialist, Appeals & Grievances.
Key Responsibilities
Research and resolve member and provider complaints in compliance
with regulatory standards
Prepare appeal summaries and correspondence, ensuring accuracy and
adherence to guidelines
Analyze claims processing and provider contracts to determine root
causes of payment errors
Required Qualifications
High School Diploma or equivalent
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, Amarillo , Appeals and Grievances Specialist, Other , Amarillo, Texas
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