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How much do medicare appeals manager jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for medicare appeals manager in the United States is $25.71, according to ZipRecruiter salary data. Most workers in this role earn between $19.71 and $30.53 per hour, depending on experience, location, and employer.

What does a Medicare Appeals Manager do?

A Medicare Appeals Manager oversees and coordinates the appeals process for denied Medicare claims within a healthcare organization. They ensure that all appeals are handled efficiently and in compliance with federal and state regulations. Their responsibilities include reviewing denied claims, preparing necessary documentation, communicating with patients and healthcare providers, and staying updated on Medicare policies. The goal of a Medicare Appeals Manager is to maximize successful appeal outcomes and minimize financial loss for the organization.

What are the key skills and qualifications needed to thrive as a Medicare Appeals Manager?

To thrive as a Medicare Appeals Manager, you need in-depth knowledge of Medicare regulations, appeals processes, and healthcare compliance, often supported by a bachelor's degree in healthcare administration or a related field. Familiarity with case management software, CMS guidelines, and experience with electronic health record (EHR) systems are typically required. Strong analytical skills, attention to detail, and effective communication are vital soft skills for managing complex cases and leading teams. These competencies are crucial for ensuring timely and compliant resolution of appeals, minimizing risk, and maintaining organizational integrity.

What are some common challenges faced by a Medicare Appeals Manager in handling complex cases?

A Medicare Appeals Manager often faces challenges such as navigating complex regulatory requirements, managing high volumes of appeals, and ensuring strict adherence to submission deadlines. Additionally, the role requires effective coordination between multiple departments, such as billing, compliance, and clinical teams, to gather necessary documentation. Staying updated with frequently changing Medicare guidelines and effectively communicating decisions to both patients and providers are also key aspects that demand strong organizational and interpersonal skills.
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Medicare Appeals Manager jobs near you
Infographic showing various Medicare Appeals Manager job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $53,482 per year, or $25.7 per hour.

Member Appeals & Grievances Specialist I

Triton Health Systems

Birmingham, AL • Remote

Full-time

Posted 7 days ago

Job description

Member Appeals & Grievances Specialist

Location: Birmingham, Alabama

Work Schedule: This position will primarily work from the VIVA HEALTH headquarters in downtown Birmingham. After training has been completed, there would be an opportunity to work 1 day per week from home.

Job Summary

The Member Appeals & Grievances Specialist will analyze and resolve all Medicare appeals and grievances received from members, non-contracted providers and government entities. This role will coordinate a timely resolution according to state and federal guidelines and VIVA HEALTH policies and procedures. This position will participate in an on-call rotation to process appeals and grievances on weekends and holidays.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

  • Comprehensive Health, Vision, and Dental Coverage
  • 401(k) Savings Plan with company match and immediate vesting
  • Paid Time Off (PTO)
  • 9 Paid Holidays annually plus a Floating Holiday to use as you choose
  • Tuition Assistance
  • Flexible Spending Accounts
  • Healthcare Reimbursement Account
  • Paid Parental Leave
  • Community Service Time Off
  • Life Insurance and Disability Coverage
  • Employee Wellness Program
  • Training and Development Programs to develop new skills and reach career goals
  • Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Key Responsibilities

  • Process member and non-contracted provider Medicare Part C and Part D grievances and appeals according to federal and state regulations and internal, organizational policies and procedures.
  • Collaborate with internal and external subject matter experts to obtain benefit and/or clinical opinions/interpretations.
  • Identify training, process improvement, and other ways to maximize plan performance and customer satisfaction.
  • Act as subject matter expert regarding grievances and appeals.
  • Prepare for and participate in all required audits.
  • Participate in on-call rotation on weekends and holidays.

REQUIRED QUALIFICATIONS:

  • High School diploma or GED
  • 1 – 3 years’ experience in managed care, health care customer service, or appeals and grievances
  • Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks
  • Ability to carefully follow processes in sequential order
  • Ability to meet established productivity, schedule adherence, and quality standards
  • Knowledge of computer platforms and applications of Microsoft Office
  • Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making
  • Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

PREFERRED QUALIFICATIONS:

  • Associates’ Degree
  • Experience working with the elderly population
  • 1 – 3 years’ experience processing Medicare appeals and grievances
  • Knowledge of Medicare regulations
  • Experience with administrative and/or coordinator positions with exposure to PHI