Guiding Care Appeals Specialist

Job Summary

A company is looking for a Guiding Care Appeals Specialist.

Key Responsibilities:

• Research contractual benefits and claim details to support clinical staff in appeals and grievances
• Prioritize and analyze complex appeals and ensure timely data entry
• Perform administrative duties related to file management and assist with vendor audit activities

Required Qualifications:

• 2+ years of experience in healthcare appeals, claims, or grievance resolution
• Strong knowledge of Medicaid/Medicare or other Government Program regulations
• Proficient in reading and interpreting medical documentation and insurance policies
• Experience using health plan systems for appeals intake and tracking (e.g., Facets, QNXT preferred)