Senior Grievance and Appeals Specialist - New York, United States - VillageCare

Description

Senior Grievance and Appeals SpecialistVillageCare is looking for a self-motivated individual for a Full Time role as the Senior Grievance Specialist.

This role is responsible for the investigation and resolution of all Medicare and Medicaid lines of business complaints and grievances.

Some of your daily activities will be:
Interaction with market/client contacts, as well as various internal departments.

Ensure that all regulatory reports and time frames are met by conducting on-going compliance audits to ensure compliance member satisfaction.

Oversee shared mailboxes and department e-mails to ensure cases are properly entered into department tracking system, and that grievances are acknowledged and resolved timely and accurately.

Investigate and resolve complaints, grievances, and member concerns in accordance with State and/or Plan guidelines. Handle inbound calls related to grievances, bills, appeals and access related issues. Lead investigations and responses to SDOH (State Department of Health) and CMS (Center of Medicaid and Medicare) complaints.

We would like to speak to those who have a Bachelor's Degree in a related field along with 3-5 years of Managed Long Term Care experience.

Knowledge of Medicare/Medicaid Grievance and appeals process. Proficient with general computer software including Microsoft Excel, Word and Outlook.
There are many benefits to working for VillageCare.

If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you PTO package10 Paid HolidaysPersonal and Sick time Medical/Dental/VisionHRA/FSAEducation Reimbursement Retirement Savings 403(b)Life & DisabilityCommuter BenefitsPaid Family LeaveAdditional Employee DiscountsVillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible.

We are committed to superior outcomes in quality health care. VillageCare is an Equal Opportunity Employer.