- Florida, United States
- $20–$33 per hour
- 3+ years
Coordinate Medicare appeals and grievances, ensuring compliance with CMS regulations and timely resolution.
Compensation
Typical Hourly Offer/Pay Range: $20 - $25 Hourly Pay Range: $20 - 33
Responsibilities
- Review appeal and grievance cases from various appellant types in accordance with CMS regulatory guidelines and timeframes
- Ensure cases are classified correctly and reviewed for potential expedited requests
- Resolve complex standard or expedited grievances, appeals or disputes involving expressions of dissatisfaction, reimbursement, medical necessity, utilization management and benefits
- Prioritize case workload to ensure CMS timeframes and required written notifications are met for various case types
- Access various systems such as MAAGC, JIVA, Diamond, ProviderConnect, Client Letter, ERCMS RADMD, Magellan, and Blue 2 to gather pertinent data and document resolution
Requirements
- High school diploma or GED
- Bachelor’s degree
- Nice to have: Bachelor’s degree
- Nice to have: Strong working knowledge of Medicare Advantage/ Supplement/ Frozen Products, CMS, OIR, DFS and other regulatory requirements
- Nice to have: Proven organizational skills