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Grievance and Appeals Regulatory Specialist

Responsibilities
Researches and responds to written/verbal appeals and grievances submitted by the New York State Department of Health (DOH), the Independent Consumer Advocacy Network (ICAN), as well as Complaint Tracking Module (CTM) issues from the Centers for Medicare and Medicaid Services (CMS) and inquiries addressed to VNSNY CHOICE Executive team with individual customized responses based on the issues presented by the appellant. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day operations according to defined processes and procedures. Creates and maintains accurate records documenting the actions and rationale for each grievance or appeal decision. Assists with collecting and reporting data. Works under general supervision. Education: Bachelor's Degree in health/human services, healthcare or business administration or related field or equivalent work experience required. Master's degree in public health or health-related field preferred. Experience: Minimum three years progressive professional experience in managed care grievance and appeals or a related area such as medical or utilization management required. Proficient verbal/written communication skills required. Proficient computer and typing skills and knowledge of Microsoft Office (Word and Excel) required. Ability to work in a fast paced environment and effectively manage multiple grievances and appeals simultaneously required.

ABOUT US

The Visiting Nurse Service of New York (VNSNY) is one of the nation's largest not-for-profit home- and community-based health care organizations, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost-effective health care in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, health plan members, and clients from before birth to the end of life. On any given day, VNSNY employees - including nurses, rehabilitation therapists, social workers, home health aides and other professionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to approximately 40,000 individuals in our care helping them to live the best lives possible in their homes and communities.