Member Appeals & Grievances Specialist

I VIVA HEALTH - 3.3

Birmingham, AL Job Details 1 day ago Benefits Wellness program Paid parental leave Paid holidays Disability insurance Health insurance Dental insurance Flexible spending account Tuition reimbursement Paid time off Parental leave Employee assistance program Vision insurance 401(k) matching Life insurance Qualifications High school diploma or GED Desktop applications Productivity software

Full Job Description Member Appeals & Grievances Specialist Location:

Birmingham, Alabama Work Schedule:

This position will primarily work from the

VIVA HEALTH

headquarters in downtown Birmingham. After training has been completed, there would be an opportunity to work 1 day per week from home. Job Summary The Member Appeals & Grievances Specialist will analyze and resolve all Medicare appeals and grievances received from members, non-contracted providers and government entities. This role will coordinate a timely resolution according to state and federal guidelines and

VIVA HEALTH

policies and procedures. This position will participate in an on-call rotation to process appeals and grievances on weekends and holidays. Why

VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH

has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare. Benefits Comprehensive Health, Vision, and Dental Coverage 401(k) Savings Plan with company match and immediate vesting Paid Time Off (PTO) 9 Paid Holidays annually plus a Floating Holiday to use as you choose Tuition Assistance Flexible Spending Accounts Healthcare Reimbursement Account Paid Parental Leave Community Service Time Off Life Insurance and Disability Coverage Employee Wellness Program Training and Development Programs to develop new skills and reach career goals Employee Assistance Program See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits (https://www.vivahealth.com/careers/benefits) Key Responsibilities Process member and non-contracted provider Medicare Part C and Part D grievances and appeals according to federal and state regulations and internal, organizational policies and procedures. Collaborate with internal and external subject matter experts to obtain benefit and/or clinical opinions/interpretations. Identify training, process improvement, and other ways to maximize plan performance and customer satisfaction. Act as subject matter expert regarding grievances and appeals. Prepare for and participate in all required audits. Participate in on-call rotation on weekends and holidays.

REQUIRED QUALIFICATIONS

: High School diploma or

GED 1 - 3

years' experience in managed care, health care customer service, or appeals and grievances Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks Ability to carefully follow processes in sequential order Ability to meet established productivity, schedule adherence, and quality standards Knowledge of computer platforms and applications of Microsoft Office Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

PREFERRED QUALIFICATIONS

Associates' Degree Experience working with the elderly population 1 - 3 years' experience processing Medicare appeals and grievances Knowledge of Medicare regulations Experience with administrative and/or coordinator positions with exposure to PHI Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.