Appeals Manager

dac.nc.gov

North Carolina, US
$63,927 - $111,871 py
Hybrid
Medicaid appeals and grievances
Due process compliance
Provider and vendor compliance monitoring
The purpose of the Hearings and Appeals Unit is to provide coordination of fee for service appeals and grievances by providers, beneficiaries and claimants and provide oversight and monitoring of appeals and grievances under managed care

Job Summary

  • The purpose of the Hearings and Appeals Unit is to provide coordination of fee for service appeals and grievances by providers, beneficiaries and claimants and provide oversight and monitoring of appeals and grievances under managed care.
  • The purpose of this position is to work as an integral member of the Medicaid Appeals team that provides oversight of appeal and grievance functions, processes, and initiatives, troubling shooting issues, and other tasks and items that arise for Medicaid Beneficiary Appeals and grievances and Provider Claim appeals.
  • The State of North Carolina offers excellent comprehensive benefits including health insurance, retirement plans, and paid leave.

Matching Summary

The purpose of the Hearings and Appeals Unit is to provide coordination of fee for service appeals and grievances by providers, beneficiaries and claimants and provide oversight and monitoring of appeals and grievances under managed care.

Salary

$63,927 - $111,871

Skills & Requirements

Must-have

  • Medicaid appeals and grievances
  • Due process compliance
  • Provider and vendor compliance monitoring
  • Stakeholder coordination
  • Legal and compliance functions

Nice-to-have

  • Effective working relationships
  • Healthcare industry knowledge
  • Program management understanding
  • Microsoft Office proficiency

Key Requirements

  • Master's degree or Bachelor's degree in assignment area
  • 3-5 years of closely related experience
  • Equivalent combination of education and experience

Work Rights

Not specified

Tailored Resume

Cover Letter