Grievance and Appeals Specialist (Hybrid)

Now Hiring: Grievance & Appeals Specialists
New York, NY | Hybrid/Onsite | Full-Time
$30-$35/hour

Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid Managed Care? We're partnering with a leading healthcare organization that's looking to add multiple specialists to their growing team.

If you're someone who thrives in a fast-paced environment, understands CMS regulations, and enjoys ensuring members receive timely, accurate resolutions, we'd love to connect with you.
What You'll Do

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  Review, investigate, and resolve member and provider grievances and appeals
  
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  Ensure all cases are processed within CMS, Medicare, Medicaid, and New York State regulatory timelines
  
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  Partner with Medical Directors, Claims, Provider Relations, Pharmacy, and other departments to resolve cases efficiently
  
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  Prepare clear, professional written correspondence for members, providers, and regulatory agencies
  
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  Track appeal deadlines and maintain accurate case documentation
  
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  Assist with Fair Hearings, External Appeals, and Independent Review Entity (IRE) cases
  
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  Escalate complex cases when appropriate
  
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  Support audits and contribute to process improvement initiatives
  

What We're Looking For

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  At least 2 years of Grievance & Appeals experience in a Medicare and/or Medicaid Managed Care environment
  
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  Strong knowledge of CMS, Medicare, Medicaid, and New York State regulations
  
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  Excellent communication and organizational skills
  
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  Detail-oriented with strong analytical abilities
  
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  Proficiency with Microsoft Office
  
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  Experience with FACETS is a plus
  
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  Bachelor's degree preferred (or equivalent experience)
  

Compensation
$30-$35/hour, based on experience.

If you're ready for your next opportunity—or know someone who is—we'd love to hear from you. Apply today or message me directly for more information. Referrals are always welcome!