Healthcare Dispute Resolution Specialist
4 days ago
We are seeking an experienced professional to join our team as a Medicare Member Complaints, Appeals and Grievances (MCAG) specialist. The successful candidate will have excellent communication and problem-solving skills, and the ability to work effectively in a fast-paced environment. Key responsibilities include reviewing and resolving Medicare member complaints and appeals, communicating resolution to members or authorized representatives, and ensuring compliance with state, federal, and Sonder Health Plans' policies and procedures.
About the Job
This is a full-time position that offers a competitive salary and benefits package, including health insurance, retirement plan, and paid time off. If you are a motivated and detail-oriented individual who is passionate about delivering exceptional customer service, we encourage you to apply.
Key Responsibilities
- Review and resolve Medicare member complaints and appeals
- Communicate resolution to members or authorized representatives
- Ensure compliance with state, federal, and Sonder Health Plans' policies and procedures
- Prioritize and organize tasks to meet compliance deadlines
- Research issues utilizing systems and clinical assessment skills, knowledge, and approved 'Decision Support Tools' in the decision-making process
Requirements
- High School Diploma or GED
- 1 year of experience working with managed care plans or a related field
- Familiarity with Medicare claims denials and appeals processing, and CMS guidelines for appeals, denials, and grievances
- LVN/LPN or completion of other healthcare-related vocational program with certification (e.g., Certified Coder, billing, medical assistant)
Estimated Salary: $65,000 per annum
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