Description We are Medical IPA, an industry-leading healthcare organization. We are committed to offering superior health-related services and exceptional patient experiences. To augment our dedicated team, we are seeking an experienced Medical Appeals and Grievance Specialist. Position Overview: In this role, you will be responsible for reviewing, investigating, and resolving various appeals and grievances related to medical care, services, and our health plans. We are searching for a candidate who is well-versed in healthcare policies and regulations and can navigate the ins and outs of medical benefits and claims. Responsibilities:
Investigate, manage, and resolve all medical appeals and grievances within mandated deadlines. - Ensure adherence to all state and federal regulations regarding the administration of appeals and grievances. - Coordinate with physicians, medical staff, and other departments to gather data needed for appeals and grievances reviews. - Prepare and maintain various reports regarding the status of appeals and grievances issues. - Recommend and implement improvements in appeals and grievance procedures. - Conduct and facilitate training for staff on proper procedures for handling appeals and grievances. Requirements - Minimum of 3 years of experience in an appeals and grievances role, specifically in the healthcare sector. - Comprehensive knowledge of healthcare terms, benefits, and claim processing. - Strong understanding of local, state, and federal healthcare policies and regulations. - Exceptional communication, analytic and problem-solving skills. - Proficient in Microsoft Office Suite.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https:///www.roberthalf.com/us/en/terms) .