- Novo Nordisk Inc. (Plainsboro, NJ)
- …Audits and Other Responsibilities Support and manage State tax inquires, audits and appeals . Identify, quantify, and report State tax risk for biannual internal tax ... risk reporting to Corporate Tax as well as prepare risk memos for key risks Manage processes, technology, and resources to ensure that deliverables are properly planned, executed, and provided in a manner aligned with best practices Support ad hoc projects as… more
- City of New York (New York, NY)
- …health and safety, and increasing opportunities for equitable growth. Your Team The Appeals Operations Coordinator will be a key member of the Division of ... Management (CRM). The Division of Adjudications consists of the Appeals and the Mitchell-Lama Hearings Units. - The ...Appeals and the Mitchell-Lama Hearings Units. - The Appeals Unit conducts federally mandated informal hearings and reviews,… more
- Centene Corporation (Indianapolis, IN)
- …MUST RESIDE IN INDIANA **Position Purpose:** Ensure appropriate processing of member grievance appeals , provider appeals , or request for a State Fair Hearing. ... the day to day responsibilities of the Grievance & Appeals Coordinators. + Ensure that the Grievance and ...Appeals Coordinators. + Ensure that the Grievance and Appeals department processes all appeals and grievances… more
- New York State Civil Service (Albany, NY)
- …Agency Court Administration, Office of Title Administrative Assistant Court of Appeals Series Occupational Category Administrative or General Management Salary Grade ... and a keen attention to detail. One position will be assigned to the Appeals department. Under the direction of the Clerk, Deputy Clerk and Assistant Deputy… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or… more
- CareFirst (Baltimore, MD)
- …**PURPOSE:** This Position will support government programs lines of business. The Appeals Specialist II will be responsible for the initial analysis of ... appeals correspondence, and determination of next steps, with minimal...and tracking information to facilitate and expedite processing of appeals received from a variety of sources. Responsible for… more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and ... appeals functions to include coordination of specific process and...Responsibilities: | Prepares necessary documentation for utilization management and appeals processes, performs data management and coordinates communication between… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the...assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high level of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating ... clinical and medical coding skills to review provider claim appeals for medical necessity, appropriate coding, and pricing of...eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Officer** **Job Class: Revenue Tax Specialist Senior or Revenue Tax Specialist Principal** **Agency: Revenue Department** + **Job ID** : ... Unit** : Revenue Dept / Revenue (inc Assessors)-MAPE + **Division/Unit** : Appeals & Legal Services / Appeals 1 + **Work Shift/Work Hours** : Day Shift + **Days… more
- R1 RCM (Chicago, IL)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Supervisor** , you will support clinical coders and coding team ... conduct a comprehensive review of coding denials and formulate appeals based on documentation and/or make coding change suggestions...what you will experience working as a Clinical Coding Appeals Supervisor:** + Track daily inventory of cases and… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeals and Grievances (A&G) Analyst, you will be responsible for assisting with all operational aspects of appeals and grievances, in ... effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. + Collaborates closely with beneficiaries, healthcare providers, and… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Appeals intake coordinator position is focused on the processing of incoming member and provider Medicare appeals and grievances. This team ... member will screen incoming complaints and appeals for level of urgency, benefit or medical necessity...teams as necessary to effectively triage incoming complaints and appeals . Essential Functions + Triaging of incoming appeals… more
- Elevance Health (Richmond, VA)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level position in...an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre… more
- Point32Health (MA)
- …and communities. **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed entries ... from the Grievance and Appeals systems. Checks cases built by other associates to...findings and identifies areas of opportunity for the A&G ( Appeals and Grievances) department. Understands department, segment, organizational strategy… more
- University of Utah Health (Salt Lake City, UT)
- …Supervise the day-to-day activities of staff who process member and provider Grievance and Appeals . + Monitor and set goals for staff workloads. + Ensure that staff ... are processing Grievances and Appeals efficiently and in compliance with applicable policies, regulations,...+ Provide education to staff and other departments on Appeals and Grievances. + Develop process improvement initiatives, including… more
- ManpowerGroup (Columbia, SC)
- Our client, a leader in the healthcare industry, is seeking an Analyst, Appeals to join their team. As an Analyst, Appeals , you will be part of the clinical ... review department supporting the appeals team. The ideal candidate will have strong analytical...will align successfully in the organization. **Job Title:** Analyst, Appeals **Location:** Columbia, SC **Pay Range:** Not specified **What's… more
