Medicaid Appeals Specialist

A company is looking for an Associate Specialist, Appeals & Grievances (Provider Medicaid / Marketplace).

Key Responsibilities

Enter denials and requests for appeals into the information system and prepare documentation for review

Research claims issues and assure timeliness and appropriateness of appeals according to guidelines

Generate and mail denial letters, and collaborate with provider and member services to resolve complaints

Required Qualifications

At least 1 year of experience in claims or customer / provider service in a healthcare setting

Customer service experience

Organizational and time management skills

Proficiency in Microsoft Office suite or applicable software programs

Completion of a healthcare-related vocational program is preferred