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Medicare Grievance Analyst Jobs

Program Director (Medicare) Jobs
By Cognosante, LLC At , Remote $156,016 - $249,630 a year
Oversight of a large Contact Center staffed with Trained Medicare Specialists handling case management activities.
Oversight and reporting to management and client for Financial Management Operations and legislative reporting functions.
Experience finding trends, errors, and reviewing data with report writing skills.
Project Management Professional (PMP) Certified.
Develop and maintain knowledge, awareness, and understanding of company policies and procedures, goals, and objectives.
Bachelor’s degree in a business discipline plus 5 years’ program/project experience working in government programs such as Medicare and Medicaid.
Medicare Specialist - Remote ($18.91 - $28.03 / Hour)
By Talentify.io At United States
Required Experience, Education And Skills
High School Diploma/GED or equivalent combination or education and experience required.
Basic math and computer skills. The ability to type 30 words per minute is a requirement.
Knowledge of medical terminology and the ability to understand and assess medical documents is strongly preferred.
Experience handling first-party medical claims is preferred.
Negotiating skills and the ability to develop effective negotiating strategies.
Cigna Medicare Clinical Operations Lpn/Lvn Case Management Analyst - Precertification-
By Cigna At , Nashville, 37214, Tn

Manager will provide If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds ...

Medicare Compliance Specialist, Remote
By AllWays Health Partners At , Somerville, Ma
Knowledge/experience with federal, state and payer-specific regulations
Work is normally performed in a typical remote work environment.
Bachelors Degree or substitution of 5+ years of work experience.
3+ years of experience in the health care industry
Experience in performing highly analytical and critical thinking work
Experience in health care compliance
Account Manager-Medicare Advantage Jobs
By CVS Health At , , Ny $43,700 - $100,000 a year

We are searching for experienced Account Managers, well-versed in Medicare Advantage plans to support a large group account. The Account Manager will spend the majority of their day away from the ...

Medicare Product Associate Jobs
By Devoted Health At , Remote $88,100 - $98,700 a year
The Associate will be part of a small team working in a fast-paced environment, requiring excellent time management and prioritization skills.
Qualifications (Minimum education & experience level required):
Experience with Health Plan Management System (HPMS) and CMS PBP software preferred.
Experience with benefit development, CMS bid submissions, benefit implementation, regulatory documents, or claims experience is ideal.
This position requires the candidate to have experience in healthcare, preferably with Medicare programs.
This is a highly visible role and strong interpersonal skills are a necessity.
Medicare Product Associate Jobs
By Devoted Health At United States
The Associate will be part of a small team working in a fast-paced environment, requiring excellent time management and prioritization skills.
Qualifications (Minimum education & experience level required):
Experience with Health Plan Management System (HPMS) and CMS PBP software preferred.
Experience with benefit development, CMS bid submissions, benefit implementation, regulatory documents, or claims experience is ideal.
This position requires the candidate to have experience in healthcare, preferably with Medicare programs.
This is a highly visible role and strong interpersonal skills are a necessity.
Um Administrative Coordinator- Medicare- Wah Mon-Fri 9Am-6Pm Est
By Humana At , Tampa, 33610, Fl
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
1+ years administrative or customer service experience
Excellent verbal and written communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proven experience working with tight deadlines/timeframe in an ever changing environment
Proficient and/or experience with medical terminology and/or ICD-10 codes
Um Administrative Coordinator- Medicare- Wah Mon-Fri 9Am-6Pm Est
By Humana At , Lancaster, 29720, Sc
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
1+ years administrative or customer service experience
Excellent verbal and written communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proven experience working with tight deadlines/timeframe in an ever changing environment
Proficient and/or experience with medical terminology and/or ICD-10 codes
Lpn/Lvn Case Management Analyst - Precertification- Medicare - Remote
By Cigna At , Nashville, 37214, Tn

Position Summary: Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of ...

Grievance And Appeals Representative 3
By Humana At , Tampa, 33610, Fl
Must meet all Work at home (WAH) requirements
Humana will provide work at Home associates with telephone equipment appropriate to meet the business requirements for their position/job
Prior experience interpreting Member Benefits and Medical Claims
Experience with the ability to prioritize and manage inventory and workflow
Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Pharmacy Benefit Analyst, Medicare
By Premera Blue Cross At , Remote $65,500 - $105,800 a year
Experience in proactively applying analytical, problem solving and / or technical abilities to daily responsibilities.
In-depth knowledge of pharmacy benefit coding.
Must have Medicare Part D Benefit Experience
Strong written and verbal communication skills, and ability to experience, establish and maintain effective relationships.
Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database.
Bachelor’s degree or four years equivalent experience. (Required)
Medicare Sales Jobs
By MVP Health Care At , Williston, 05495, Vt
Demonstrated time management and project planning skills. Must possess good problem-solving capabilities.
Outlook Word for windows, desired and basic data entry/typing skills.
Customer relationship management data fluency desired.
Excellent presentation, written and oral communication skills including public speaking.
Knowledge of PowerPoint and Excel (or comparable program) helpful
Demonstrated mastery of consultative sales process via successful sales track record.
Medicare Advantage Appeals And Grievance Nurse
By Blue Cross and Blue Shield of Kansas City At , Remote
Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals.
Competitive benefits package with day one eligibility
Maintains a current knowledge of CMS rules and regulations relating to the grievance and appeal processes.
Formulates determination language that resolves member or provider issues in a manner consistent with regulatory and accrediting agency requirements
Provides training, leadership and mentoring for less experienced appeal RN and administrative staff.
2 years of appeals and UM experience in a payer-based environment
Business Analyst Ii- Medicare Compliance (Remote)
By UPMC At , Pittsburgh, 15219, Pa $25.52 - $44.13 an hour
Master's degree preferred. Extensive related experience will be considered.
Minimum of two years of related work experience in financial and/or medical analysis required.
Knowledgeable with SharePoint, Access and PowerBi
Experience in health care insurance or health care industry preferred.
Preferred knowledge: SharePoint, Access and PowerBi
Identify trends in expenses, utilization, medical quality, and other areas.
Vp Medicare Operations Jobs
By University Medical Center of El Paso At , El Paso, 79905, Tx

Job Summary Responsible for overall planning, organization, start-up organization, direction of the Medicare operational areas of El Paso Health as assigned by the President and CEO. Reports ...

Grievance And Appeals Representative 3
By Humana At , San Juan, 00918, Pr
Must meet all Work at home (WAH) requirements
Humana will provide work at Home associates with telephone equipment appropriate to meet the business requirements for their position/job
Prior experience interpreting Member Benefits and Medical Claims
Experience with the ability to prioritize and manage inventory and workflow
Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Medicare Sales Executive Jobs
By Intermountain Healthcare At , Las Vegas, Nv $42.81 - $66.08 an hour
Intermediate computer skills including experience with word processing, databases, and spreadsheets.
Five years of health insurance industry experience.
Complete AHIP or NAHU Medicare certification training within 2 months of licensing.
Demonstrated effective organization and communication skills.
Demonstrated knowledge of health insurance plan concepts, operations and regulations.
Demonstrated excellent written, verbal and presentation skills with proven ability to communicate with mature customers, staff, peers, external organizations and groups.
Manager, Sales (Medicare) Jobs
By Medicare At , Tucson, Az

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll ...

Um Administrative Coordinator- Medicare- Wah Mon-Fri 9Am-6Pm Est
By Humana At , Atlanta, 30338, Ga
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
1+ years administrative or customer service experience
Excellent verbal and written communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proven experience working with tight deadlines/timeframe in an ever changing environment
Proficient and/or experience with medical terminology and/or ICD-10 codes

Are you looking for a challenging and rewarding career in healthcare? Join our team as a Medicare Grievance Analyst and help ensure that our members receive the highest quality of care!

Overview:

A Medicare Grievance Analyst is responsible for reviewing and resolving customer complaints and grievances related to Medicare services. They must ensure that all complaints are addressed in a timely manner and that all customer inquiries are answered accurately and efficiently.

Detailed Job Description:

A Medicare Grievance Analyst is responsible for reviewing and resolving customer complaints and grievances related to Medicare services. They must ensure that all complaints are addressed in a timely manner and that all customer inquiries are answered accurately and efficiently. The analyst must be able to interpret and apply Medicare regulations and policies, as well as state and federal laws. They must also be able to identify and resolve customer issues in a timely and efficient manner.

What is Medicare Grievance Analyst Job Skills Required?

• Excellent customer service skills
• Knowledge of Medicare regulations and policies
• Ability to interpret and apply state and federal laws
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to multitask and prioritize tasks
• Strong problem-solving and analytical skills
• Knowledge of medical terminology
• Knowledge of computer systems and software

What is Medicare Grievance Analyst Job Qualifications?

• Bachelor’s degree in healthcare administration, business administration, or related field
• At least two years of experience in a customer service or healthcare setting
• Knowledge of Medicare regulations and policies
• Ability to interpret and apply state and federal laws
• Excellent communication and interpersonal skills

What is Medicare Grievance Analyst Job Knowledge?

• Knowledge of Medicare regulations and policies
• Knowledge of medical terminology
• Knowledge of computer systems and software
• Knowledge of customer service principles and practices
• Knowledge of healthcare administration principles and practices

What is Medicare Grievance Analyst Job Experience?

• At least two years of experience in a customer service or healthcare setting
• Experience in a Medicare-related role
• Experience in a grievance or complaint resolution role

What is Medicare Grievance Analyst Job Responsibilities?

• Review and resolve customer complaints and grievances related to Medicare services
• Interpret and apply Medicare regulations and policies, as well as state and federal laws
• Identify and resolve customer issues in a timely and efficient manner
• Respond to customer inquiries accurately and efficiently
• Maintain accurate records of customer complaints and grievances
• Monitor customer satisfaction levels and take appropriate action to address any issues