Medicare Appeals Analyst

Position Overview:

• This role is a central point of contact for Appeals and Grievances staff, providing analytical problem-solving and regulatory compliance support.
• The position coordinates activities to maintain compliance and supports process improvements across the department.

Responsibilities:

• Leads departmental process improvements and projects, represents the department on inter-departmental projects, and responds to inquiries from internal and external partners.
• Assists with research, evaluation, and development of policies and procedures based on training needs identified for Facets inquiries.
• Serves as the unit’s subject matter expert on appeals module configuration and supports data validation, reporting, and compliance activities.

Qualifications:

• Requires 3 years of Appeals and Grievances experience and a Bachelor’s degree in business administration, health care administration, information systems, or a related field.
• Demonstrated competency in Windows, Microsoft Office, and navigation in FACETS/Customer Service & Appeals modules.
• Strong knowledge of Federal and State Regulatory requirements surrounding appeals, including Medicare, Act 68, ERISA, HIPAA, and NCQA.