Director of Provider Appeals
Company: VirtualVocations
Location: Grand Forks
Posted on: April 6, 2025
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Job Description:
A company is looking for a Director, Provider Appeals &
Grievances.
Key Responsibilities
Lead and direct the Appeals & Grievances unit in reviewing and
resolving member complaints
Provide oversight and training to local plans' provider dispute and
appeals units to ensure compliance with Medicare standards
Analyze grievance and appeals data to identify trends and implement
process improvements for member satisfaction
Required Qualifications
Associate's Degree or 4 years of Medicaid grievance and appeals
experience
7 years of experience in healthcare claims review and member
appeals processing, including 2 years in a managerial role
Experience with various medical claim types, including HCFA 1500
and inpatient/outpatient claims
2 years of supervisory/management experience in a managed care
setting
Bachelor's Degree is preferred
Keywords: VirtualVocations, Grand Forks , Director of Provider Appeals, Executive , Grand Forks, North Dakota
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