Medicare Appeals & Grievances Coordinator

Optum; Pearland (TX); On-site; USD 28,000 - 50,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401(k) contribution

Job summary

Kelsey-Seybold Clinic - Pearland, part of the Optum family, is hiring an Appeals & Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals. The role acts as the primary CMS liaison and orchestrates case resolutions with relevant stakeholders to ensure CMS regulatory compliance.

The position requires at least 1 year of managed care experience with appeals and grievances, and involves data reporting and training to support CMS standards.

Qualifications

• 1+ years managed care experience in a managed care environment working with appeals and grievances.
• Experience with Medicare Advantage or CMS processes is a plus.
• Proficiency with MS Access and Excel is a plus.

Responsibilities

• Actively manages Medicare reconsiderations, grievances, and appeals following CMS rules.
• Serve as primary liaison for the CMS regional office regarding appeals and complaints.
• Coordinate resolutions with delegated parties and prepare case reports for CMS audits.
• Develop and deliver training/resources to ensure CMS regulatory compliance.

Skills

Managed Care experience

Appeals & Grievances

CMS knowledge

Job description

Kelsey-Seybold Clinic - Pearland, part of the Optum family, is hiring an Appeals & Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals. The role acts as the primary CMS liaison and orchestrates case resolutions with relevant stakeholders to ensure CMS regulatory compliance.

The position requires at least 1 year of managed care experience with appeals and grievances, and involves data reporting and training to support CMS standards.