Director of Provider Appeals

A company is looking for a Director, Provider Appeals & Grievances. Key Responsibilities Lead and direct the Grievance and Appeals Unit to resolve member complaints in compliance with Medicare standards Oversee and train local plans' provider dispute and appeals units to ensure adherence to regulations Analyze grievance and appeals data to identify trends and implement process improvements for member satisfaction Required Qualifications Associate's Degree or 4 years of Medicaid grievance and appeals experience 7 years of experience in healthcare claims review and member appeals processing, including 2 years in a management role Experience with various medical claims types, including HCFA 1500 and UB92 2 years of supervisory experience in appeals/grievance processing within a managed care setting Bachelor's Degree preferred

Apr 3, 2025 - 05:30

A company is looking for a Director, Provider Appeals & Grievances. Key Responsibilities Lead and direct the Grievance and Appeals Unit to resolve member complaints in compliance with Medicare standards Oversee and train local plans' provider dispute and appeals units to ensure adherence to regulations Analyze grievance and appeals data to identify trends and implement process improvements for member satisfaction Required Qualifications Associate's Degree or 4 years of Medicaid grievance and appeals experience 7 years of experience in healthcare claims review and member appeals processing, including 2 years in a management role Experience with various medical claims types, including HCFA 1500 and UB92 2 years of supervisory experience in appeals/grievance processing within a managed care setting Bachelor's Degree preferred