Remote CTM & Appeals Coordinator (Medicare)

E2E Alignment Healthcare USA, LLC; California (MO); Hybrid; USD 48.000 - 73.000; Vollzeit

Zusammenfassung

Alignment Health is seeking a remote CTM Specialist to monitor the CTM portal daily, acknowledge cases, and gather information from members, providers, and internal departments to resolve issues ahead of CMS deadlines.

You will draft CMS-facing correspondence, document case histories for committee meetings, and prepare monthly and quarterly reports while ensuring CMS guidelines and plan policies are followed.

Qualifikationen

• At least 1 year of Member Services or similar experience.
• 2+ years of experience with Medicare Advantage plans.
• Direct CTM experience with a Medicare Advantage plan is preferred.

Aufgaben

• Monitor the CTM portal daily and acknowledge receipt of cases.
• Gather pertinent information from members, providers and internal departments to resolve issues per policy and CMS deadlines.
• Draft CMS-facing correspondence and prepare clear case histories for committee meetings.
• Prepare monthly and quarterly reports and assist in regulatory audits and compliance reporting.
• Ensure all CTM cases, grievances and appeals comply with CMS guidelines and plan policy.

Kenntnisse

Communication skills

CMS correspondence

Typing 40 wpm

Multitasking

Bilingual EN/ES

Ausbildung

High school diploma or GED

Associate degree preferred

Jobbeschreibung

Alignment Health is seeking a remote CTM Specialist to monitor the CTM portal daily, acknowledge cases, and gather information from members, providers, and internal departments to resolve issues ahead of CMS deadlines.

You will draft CMS-facing correspondence, document case histories for committee meetings, and prepare monthly and quarterly reports while ensuring CMS guidelines and plan policies are followed.