What are the responsibilities and job description for the Appeals and Grievance Specialist position at VirtualVocations?
A company is looking for an Appeals and Grievance Specialist.Key Responsibilities : Manage the resolution process of medical and pharmacy member appeals and grievancesEnsure compliance with regulatory requirements and accreditation standardsCoordinate management of member complaints and grievances with internal departments and external vendorsQualifications : Bachelor's degree in Health Care Administration or related field, or equivalent experience2 years of experience in a managed care organizationExperience with Medicare appeals and grievances processesKnowledge of CMS, MassHealth, and DHHS contractual provisions preferredExperience in conflict resolution is highly desirable
