Appeals and Grievances Quality Analyst- Kelsey Seybold - Remote in TX or LA

Pinnacle Method Consulting's mission is to help job seekers reach their career peak by accessing top-tier opportunities. We are not a staffing firm or agency. Pinnacle Method does not hire for these roles—we systematically source and verify them from premier employers.Employer Industry: Healthcare ServicesWhy Consider This Job Opportunity Salary up to $36.44 per hour based on full-time employment Comprehensive benefits package that includes incentive and recognition programs, equity stock purchase, and 401k contribution Opportunity for career advancement and growth within the organization Supportive and collaborative work environment Chance to make a positive impact on patient care and satisfactionWhat To Expect (Job Responsibilities) Lead quality reviews for various operations departments, including Appeals & Grievances and Enrollment Analyze eligibility data and review CMS transaction reports to identify errors and optimize workflows Monitor appeals and grievances for timeliness and accuracy, ensuring documentation consistency Create, analyze, and submit reports for CMS audits and compliance monitoring Collaborate with IT and management to troubleshoot system issues and recommend process improvementsWhat Is Required (Qualifications) High School diploma or equivalent 3+ years of experience with Healthcare Appeals and Grievances 2+ years of Medicare Advantage experience Knowledge of CMS Regulations, including Appeals and Grievances, Enrollment, and Member Services Demonstrated analytical skills, including file format manipulation and data comparisonHow To Stand Out (Preferred Qualifications) Epic Managed Care experience Experience in Health Plan Operations within the Healthcare Industry Knowledge of CMS Audits Proven ability to analyze and report on appeals and grievance trends and quality error rates#HealthcareServices #PatientCare #CareerOpportunity #CompetitivePay #HealthPlanOperationsWe prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.#PinnacleMethodConsulting