Senior Director of Provider AppealsVirtualVocations • Olympia Heights, Florida, United States
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Senior Director of Provider Appeals
VirtualVocations • Olympia Heights, Florida, United States
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for a Senior Director, Provider Appeals.
Key Responsibilities
Develop and maintain the strategic roadmap for the provider appeals program, ensuring compliance with regulatory requirements
Oversee daily operations and staff management of provider appeals, ensuring timely resolution within mandated timeframes
Ensure compliance with CMS regulations and maintain audit-ready documentation practices
Required Qualifications and Education
7+ years of experience in appeals, utilization management, claims review, or clinical adjudication
Deep understanding of CMS Medicare Advantage Part C requirements and appeal decision standards
Bachelor's degree in Healthcare Administration, Business, or a related field
Experience in case review and writing defensible rationales
Preferred : Master's degree
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Director Of Provider • Olympia Heights, Florida, United States
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