Medicare Appeals & Grievances Specialist

viva health•Birmingham, AL

58d•Hybrid

About The Position

The Medicare Appeals & Grievances Specialist is responsible for intake of all Medicare appeals and grievances received from members, non-contracted providers, and government entities in a timely and accurate manner. This position will assist in processing the intake of appeals and grievances from mail, email, fax, and other electronic means and is responsible for ensuring appeals and grievances are entered correctly and timely into the department's database system. Will assist in the coordination of a timely resolution according to federal and state guidelines and VIVA HEALTH policies and procedures.

Requirements

High School Diploma or GED
1+ years' experience working in managed care, healthcare customer service, or appeals and grievances
Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks
Ability to carefully follow processes in sequential order
Ability to meet established productivity, schedule adherence, and quality standards
Attention to detail and ability to meet strict deadlines
Ability to learn and use various computer platforms and ability to use applications of Microsoft Office
Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making
Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

Nice To Haves

Associate's Degree
1+ years' experience processing Medicare appeals & grievances
Knowledge of Medicare regulations
Experience with administrative and/or coordinator positions with exposure to protected health information (PHI)

Responsibilities

Record appeals and grievances in the department's system(s) timely and accurately, ensuring all necessary documentation is uploaded with the case.
Classify member and non-contracted provider Medicare grievances and appeals according to federal and state regulations, also internal and organizational policies and procedures.
Route appeals and grievances to other departments as needed for investigation to resolve the cases.
Maintain production and quality goals in accordance with department metrics. Alert department leaders when an increase in volume might cause a backlog.