Appeals & Grievances Clinical Specialist
Remote - NYremotemid$73K – $108K
Posted today · via Workday
About this role
Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances. Duties and Responsibilities: Ensures that appeals and grievances are properly classified (e.g. denial of service, denial of payment, or a grievance about a provider) Processes appeals and grievances in accordance with internal company policy Enters data into appropriate medical management services Collaborates with other departments to thoroughly investigate appeal and grievances. Prepares for and participates in regulatory site visits. Additional duties as assigned.…
Read the full description on HFMS HF Management Services's site →
What we'd score you on
reqspace match rubricFive dimensions, recruiter-grade. Upload your resume and we'll generate a written explanation of where you fit and where the gaps are.
1
Skills match
We compare your skills against the role requirements.
2
Level fit
This role is mid-level. We check your trajectory against it.
3
Domain experience
Your work in the role's domain matters more than your years total. We weight recent and direct experience.
4
Recency
A skill you used last quarter weighs more than one from five years ago. We grade on recency, not lifetime.
5
Location fit
This role is remote-eligible — we factor in your stated location and time-zone overlap.
Score yourself on this role.
Free · no card · written explanation included