Medicare Appeals Director

Job Summary

A company is looking for a Director, Appeals & Grievances (Medicare / Provider Claims).

Key Responsibilities

• Lead and direct the Appeals & Grievances unit to resolve member complaints according to Medicare standards
• Provide oversight and training for local plans' provider dispute and appeals units
• Analyze grievance and appeals data to identify trends and implement process improvements

Required Qualifications

• Associate's degree or 4 years of Medicare grievance and appeals experience
• 7 years of experience in healthcare claims review and/or provider appeals and grievance processing, including 2 years in a managerial role
• Experience with various types of medical claims, including CMS 1500 and high dollar complicated claims
• 2 years of supervisory/management experience in a managed care setting
• Preferred: Bachelor's degree and previous Director experience