Medicare Appeals Director

Job Summary

A company is looking for a Director of Appeals & Grievances (Medicare).

Key Responsibilities

• Lead and direct the Medicare Duals Grievance and Appeals Unit to resolve member and provider complaints and disputes
• Establish department policies and procedures in compliance with federal and state regulations
• Analyze performance data and implement process improvements to enhance member and provider satisfaction

Required Qualifications

• Associate's Degree or 4 years of Medicare experience
• 7 years of experience in healthcare claims review or member appeals and grievances, including 3 years in a managerial role
• Experience with Medicare regulations, Duals, and provider disputes
• Proficient in reviewing various types of medical claims