Quality Assurance Specialist-Appeal & Grievance - Remote

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a fully remote position. The Quality Assurance Specialist Appeals & Grievances is responsible for ensuring Appeals and Grievances data accuracy, regulatory compliance, and timeliness in accordance with CMS requirements while supporting audits, reporting, training, and quality improvement initiatives to achieve Star Measurement outcomes. Job Duties/Responsibilities: - Monitors timeliness with Appeals and Grievances data, reviews case work end-to-end, ensuring workflow procedures are met to achieve Star Measure goals. - Analyzes and validates...