Medicare Appeals & Grievances Specialist

Socket.dev; Pearland (TX); On-site; USD 28,000 - 50,000; Full time

Job summary

Kelsey-Seybold Clinic in Pearland, part of the Optum family, seeks an Appeals & Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals, ensuring CMS regulatory compliance and timely resolutions. You will collaborate with Medical Director, Clinic Operations, and Contracting to drive accurate filings and reporting.

The role requires 1+ year in managed care with appeals and grievances, proficiency in CMS processes, and the ability to work autonomously under deadlines.

Qualifications

• 1+ year of managed care experience handling appeals and grievances.
• Familiarity with CMS regulations and reporting requirements.
• Ability to work autonomously under deadlines.

Responsibilities

• Manage Medicare reconsiderations, grievances, and appeals.
• Coordinate with CMS regional office and delegated parties to resolve cases.
• Research, track, and resolve medical and prescription drug appeals and grievances.
• Prepare and present cases; generate CMS-compliant reports.
• Develop and deliver training/resources to meet CMS standards.

Skills

Managed Care

Appeals & Grievances

CMS Regulations

Tools

Microsoft Access

Excel

Job description

Kelsey-Seybold Clinic in Pearland, part of the Optum family, seeks an Appeals & Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals, ensuring CMS regulatory compliance and timely resolutions. You will collaborate with Medical Director, Clinic Operations, and Contracting to drive accurate filings and reporting.

The role requires 1+ year in managed care with appeals and grievances, proficiency in CMS processes, and the ability to work autonomously under deadlines.