Health Admin Services Representative

Graduate degree. • • 1 to 2 years healthcare operations experience. • • Experience in Medicare Appeals and Grievances processing. • • Experience with Medicare Part C and Part D Appeals. • • Knowledge of CMS regulations and turnaround requirements.

Roles and Responsibilities: • • Handle end-to-end appeal processing. • • Perform AOR validation and provider outreach. • • Review denial rationale and supporting clinical documentation. • • Prepare cases for Medical Director review. • • Process determinations and effectuation activities.