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Medicare Grievance Analyst Jobs

Investigator Ii - Inmate Grievance
By Texas Department Of Criminal Justice At Texas City, TX, United States
Law Enforcement & Custodial Officers System (LECOS) Retirement
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning criminal justice, clerical,
The salary for an ERS Retiree (or non-contributing member) will
Investigator Ii - Inmate Grievance
By Texas Department Of Criminal Justice At Beeville, TX, United States
Law Enforcement & Custodial Officers System (LECOS) Retirement
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning criminal justice, clerical,
The salary for an ERS Retiree (or non-contributing member) will
Medical Documentation Review Analyst - Medicare
By Peraton At United States
Strong PC knowledge and skills
Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Make claim payment decisions based on clinical knowledge
Bachelors degree and 5-7 years, Masters degree and 3-5 years or PhD and 0-2 years of relevant experience.
Strong communication and organization skills
Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
Medicare Advisor Jobs
By Medicare At , Brooklyn, 11209 $45,600 - $77,600 a year
Keep alert to competitive products and marketing practices, and to keep management informed concerning them
Understand the covered benefits, non-covered benefits, exclusions and exemptions
Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product
Disclosures and provisions of the Advantage Medicare product
Develop a presence in the local community to help generate enrollments
Conduct home visits and personalized appointments as needed to complete the enrollment process
Medicare Advisor - Ga
By Centene At , Atlanta, 30339

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll ...

Medicare Advisor Jobs
By Medicare At , Long Island $45,600 - $77,600 a year
Keep alert to competitive products and marketing practices, and to keep management informed concerning them
Understand the covered benefits, non-covered benefits, exclusions and exemptions
Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product
Disclosures and provisions of the Advantage Medicare product
Develop a presence in the local community to help generate enrollments
Conduct home visits and personalized appointments as needed to complete the enrollment process
Appeals & Grievance - Rn
By Yamhill Community Care At , Mcminnville
Knowledge of Managed Care / Medicaid requirements.
Maintains confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards.
Any combination of education and experience that would qualify candidate for the position.
Health care benefit and regulatory knowledge.
Knowledge of Oregon Medicaid grievance system requirements.
Ensures resolutions are compliant and meets turnaround times requirements dictated by policies and procedures.
Claims Compliance Analyst, Medicare
By Markel At United States
Exceptional organizational and time management skills
Bachelor’s degree or equivalent work experience
10 years of relevant work experience (12 years without bachelor’s degree)
SQL Server, Visual Basic skills preferred
Advanced to expert written and oral communication skills
Advanced analytical and problem solving skills
Medicare Pharmacy Analyst Jobs
By GeBBS Consulting At United States
Pharmacy Benefit Manager (PBM) experience
Minimum three (3) years' health related experience with health plan, pharmacy, managed care organization
Active Certified Pharmacy Technician (PTCB CPhT Certification) required
Previous Medicare Part D and/or Pharmacy Claims experience preferred.
Proficient working knowledge of MS Office Suite.
Medicare Pharmacy Analyst Jobs
By Intuitive Technology Group At United States
Knowledge of Medicare Advantage and Prescription Drug Program with a working understanding of Pharmacy Benefit Managers (PBMs).
Experience in Project Management and the ability to prepare project plans and participate or lead special projects.
Oversee Pharmacy Benefits vendors and review claims for accuracy.
Submit changes and benefit builds to the PBM and ensure quality assurance.
Experience as a project lead on one large-scale project with a successful completion (e.g., implementation, issue tracking, and resolution).
Prior quality assurance/testing experience related to claim adjudication & plan set-up preferred. Previous claims coding experience is also desirable.
Grievance/Appeals Analyst I (Us)
By Elevance Health At California, United States
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
12898 Towne Center Drive, Cerritos, CA
3080 Bristol Street, Costa Mesa, CA
11030 White Rock Road, Rancho Cordova, CA
1121 L St., Suite 500, Sacramento, CA
2121 N. California Boulevard, Walnut Creek, CA
Medicare Counselor (Pa Medi)
By Diakon Lutheran Social Ministries At Pottsville, PA, United States
Adheres to reporting requirements as defined by agency and PA State Department of Aging.
Responsible for providing Medicare Counseling within the PA MEDI programs.
Makes provisions for providing health insurance counseling to Medicare Beneficiaries and Medicare-eligible individuals.
Assists in the development and implementation of an outreach plan to raise awareness about PA MEDI services.
Records client data into National Data base.
Mandatory Covid-19 Vaccination Program-need covid vaccine card ot file for an exemption.
Licensed Medicare Consultant Jobs
By EMERGE At United States
Extensive benefits and PTO offered
Base salary of $21-25/hr (based on experience and licensures)
1-3 years experience selling Medicare health plans
Offer relevant information on several different carriers and plans
Bonus pay of $30-50 per enrollment
Active resident-state Health Insurance License (multiple states preferred)
Medicare Content Author Jobs
By Swingtech At Washington, DC, United States
Must have experience in technical writing and editing with demonstrated proficiency in communicating detailed Medicare- and/or healthcare-related content.
Experience working directly within or as a contractor to the Centers for Medicare & Medicaid Services is strongly preferred.
Experience in some capacity in training, e-learning development, or usability testing preferred.
Excellent verbal and written communication skills essential.
BA/MA in Communications, English, Journalism, Instructional Design, or a related field; or equivalent experience.
Experience with Iterative/Agile Development and 508 compliance a plus.
Program Manager, Medicare Advantage
By Premera Blue Cross At United States
(5) years of project/program management experience. (Required)
Experience leading projects within a Program/Project Management organization.
Professional project management work history.
Versed in multiple project management methods (e.g. Waterfall, Agile, Lean, Extreme, Prince2).
Experience working in different industries with a demonstrated history of natural progression with responsibilities and/or project size/complexity.
Develop and manage moderately complex project plans and budgets/financial data, and resource needs.
Medicare Sales Jobs
By MVP Health Care At , Burlington, Vt
Demonstrated time management and project planning skills. Must possess good problem-solving capabilities.
Bachelor's degree in Marketing, Sales, Communications or related field, or equivalent combination of education & related experience.
Experience in a Medicare Managed care setting
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.
Intelligence Analyst - Medicare
By Peraton At , $66,000 - $106,000 a year
Bachelors degree and 8-10 years experience or Masters degree and 6-8 years experience or PhD and 3-5 years experience
Experience in relational data base design, extract, and reporting
Strong computer skills including Microsoft Excel, SQL, Outlook, and PowerPoint.
Strong proven analytical ability and basic knowledge of modelling, statistics, and sampling techniques
Strong communication and organization skills
5+ years of law enforcement experience
Intelligence Analyst - Medicare
By Peraton At United States
Bachelors degree and 8-10 years experience or Masters degree and 6-8 years experience or PhD and 3-5 years experience
Experience in relational data base design, extract, and reporting
Strong computer skills including Microsoft Excel, SQL, Outlook, and PowerPoint.
Strong proven analytical ability and basic knowledge of modelling, statistics, and sampling techniques
Strong communication and organization skills
Preferred candidates will have the following areas of concentration for work experience:
Medicare Specialist (Remote) Jobs
By Sedgwick At Washington DC-Baltimore Area, United States
Thorough knowledge of claims management
Compiles, reviews and analyzes claim files and/or management reports.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Excellent oral and written communication, including persuasive writing skills
Strong analytical and interpretive skills
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
Medicare Specialist (Remote) Jobs
By Sedgwick At Delaware, United States
Thorough knowledge of claims management
Compiles, reviews and analyzes claim files and/or management reports.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Excellent oral and written communication, including persuasive writing skills
Strong analytical and interpretive skills
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.

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