Medicare Appeals & Grievances Specialist

American Health Plans; Franklin (TN); Presencial; USD 55.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Affordable Medical/Dental/Vision plans

Paid time-off and holidays

TeleDoc 24/7/365

Short- & long-term disability plans

Employee Assistance Plan (EAP)

401K with company match

Employee Referral Bonus Program

Descripción de la vacante

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., seeks an Appeals and Grievances Coordinator in Franklin, TN. The role focuses on intake, research, and timely resolution of Medicare Advantage appeals and grievances with cross-department collaboration.

You will maintain records, ensure HIPAA/compliance, and manage a caseload while meeting regulatory requirements for this full-time position.

Formación

• High school diploma required.
• Two or more years of health insurance, appeals and grievances, or comparable healthcare operations preferred.
• Medicare or Medicare Advantage appeals and grievances experience preferred.
• Experience reviewing claim denials, authorization issues, provider disputes, or member/provider correspondence preferred.
• Knowledge of CMS/HIPAA and accreditation requirements preferred.

Responsabilidades

• Receive and review appeals, grievances, complaints, and related correspondence and log them in the tracking system.
• Review incoming documentation to identify relevant information and route accordingly.
• Collaborate with Utilization Management, Claims, Compliance and other departments to complete appeals and grievances on time.
• Ensure resolutions occur within regulatory or accreditation timeframes and required guidelines.
• Prepare CMS-compliant correspondence for required communications related to appeals and reconsideration requests.
• Maintain complete electronic case records with supporting documentation and evidence of distribution.

Conocimientos

Communication skills

Customer service

Research & analysis

Attention to detail

Multitasking

Policy interpretation

Educación

High school diploma

College courses in relevant field (preferred)

Descripción del empleo

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., seeks an Appeals and Grievances Coordinator in Franklin, TN. The role focuses on intake, research, and timely resolution of Medicare Advantage appeals and grievances with cross-department collaboration.

You will maintain records, ensure HIPAA/compliance, and manage a caseload while meeting regulatory requirements for this full-time position.