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Requisition Number 20-0004
Post Date 1/13/2020
Title Member Appeals & Grievances Specialist
City Birmingham
State AL
Description Seeking Medicare Appeals Experts: come make a difference with us!
VIVA Health is seeking a Member Appeals & Grievances Specialist to analyze and resolve Medicare appeals and grievances received from members, non-contracted providers, and government entities. This position will coordinate a timely resolution according to state and federal guidelines and VIVA Health policies and procedures. This position will also participate in an on-call rotation to process appeals and grievances on weekends and holidays.
Requirements REQUIRED:
• High School diploma or GED
• 1 – 3 years’ experience in managed care, health care customer service or appeals and grievances
• Excellent written and verbal communication skills, interpersonal skills, organization skills and the ability to handle multiple tasks
• Ability to carefully follow processes in sequential order
• Ability to meet established productivity, schedule adherence, and quality standards
• Knowledge of computer platforms and applications of Microsoft Office
• Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making
• Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision
• Associates’ Degree
• Experience working with the elderly population
• 1 – 3 years’ experience processing Medicare appeals and grievances
• Knowledge of Medicare regulations
• Experience with administrative and/or coordinator positions with exposure to PHI
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An Equal Opportunity Employer