BroadPath ยท 20 hours ago
Appeals & Grievance Specialist
United States
Full-time
Remote
Entry Level
1+ years expBroadPath is dedicated to ensuring compliance with state and federal regulatory requirements, and they are seeking an Appeals and Grievance Specialist to manage and resolve member and provider complaints. The role involves acting as the primary investigator for grievances and appeals, ensuring thorough documentation and adherence to regulations.
Hospital
Hiring Manager
David G.
Responsibilities
Sending appropriate acknowledgment of the grievance/appeal; educating the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)
Gathering all relevant information from the member or provider regarding the grievance/appeal and determining the appropriate resolution of the grievance/appeal per standard policies and procedures
Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
Conducts non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appeal
Thoroughly document all action taken on behalf of the member or provider to resolve the grievance/appeal
Ensures that all grievances/appeals are processed in adherence to state and federal regulations
Qualification
Required
1+ years of Medicare Appeals/Grievance experience or Medicare Claims experience required
Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Excellent verbal and written communication skills
Ability to remain focused and productive each day though tasks may be repetitive
High school diploma or equivalent
Preferred
Processing Medicare Appeals/Grievance with Medicare Part C or D experience
Company
BroadPath
BroadPath provides transformational outsourcing and managed services powered by our one-of-a-kind, 100% remote business model.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-01-29Acquired
Leadership Team
Donald G. Hubman
Chief Executive Officer
Scott Weismiller
Chief Operating Officer
Recent News
Business Standard India
2025-12-11
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2025-02-06
2025-01-31
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