Now Hiring: Grievance & Appeals Specialists
New York, NY | Hybrid/Onsite | Full-Time
$30-$35/hour
Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid Managed Care? We're partnering with a leading healthcare organization that's looking to add multiple specialists to their growing team.
If you're someone who thrives in a fast-paced environment, understands CMS regulations, and enjoys ensuring members receive timely, accurate resolutions, we'd love to connect with you.
Review, investigate, and resolve member and provider grievances and appeals
Ensure all cases are processed within CMS, Medicare, Medicaid, and New York State regulatory timelines
Partner with Medical Directors, Claims, Provider Relations, Pharmacy, and other departments to resolve cases efficiently
Prepare clear, professional written correspondence for members, providers, and regulatory agencies
Track appeal deadlines and maintain accurate case documentation
Assist with Fair Hearings, External Appeals, and Independent Review Entity (IRE) cases
Escalate complex cases when appropriate
Support audits and contribute to process improvement initiatives
At least 2 years of Grievance & Appeals experience in a Medicare and/or Medicaid Managed Care environment
Strong knowledge of CMS, Medicare, Medicaid, and New York State regulations
Excellent communication and organizational skills
Detail-oriented with strong analytical abilities
Proficiency with Microsoft Office
Experience with FACETS is a plus
Bachelor's degree preferred (or equivalent experience)
$30-$35/hour, based on experience.
If you're ready for your next opportunity—or know someone who is—we'd love to hear from you. Apply today or message me directly for more information. Referrals are always welcome!