- Daiichi Sankyo, Inc. (Seattle, WA)
- …purpose of this role is to serve as a field-based, product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient ... of care on payer specific nuances related to utilization managements protocols and appeals Partner with DSI oncology field staff to ensure aligned customer approach.… more
- VNS Health (Manhattan, NY)
- …to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the appeals ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...Integrated Dual Advantage (FIDA) and Select Health. Ensures regulatory compliance , timeliness requirements and accuracy standards are met. Coordinates… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...eg fraud and abuse cases shall be forwarded to Compliance Department. Duties Continued Outreach to providers, vendors, hospitals,… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...judgment. This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS),… more
- Commonwealth Care Alliance (Boston, MA)
- …as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...Grievances team in a number of ways to ensure compliance on activities related to member complaints in the… 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 ... (MA), or Select Health. Ensures regulatory compliance , timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day… more
- Robert Half Accountemps (Long Beach, CA)
- Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible for ... managing all grievances, appeals and complaint processes related to medical services. You...for members and work to resolve their issues in compliance with company policies and regulations. + Provide educational… more
- McLaren Health Care (Bay City, MI)
- …ACMA or ACDIS memberships + Certified Medical Coder, Certified in Healthcare Compliance , Certified Coding Specialist , or Certified Clinical Documentation ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Houston Methodist (Houston, TX)
- …Revenue Cycle experience** At Houston Methodist, the Accounts Receivable (AR) Appeals Denials Specialist position is responsible for reviewing accounts ... S Fry Katy, TX 77450** **Looking for candidates with the following:** + ** Appeals with hospital accounts** + **Epic experience is a plus** + **Government Advantage… more
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... the success of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals . Leverage...to billing, coding, and collection practices in compliance with federal and state guidelines + Collect, analyze,… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...files for each complaint, appeal and grievance, and ensures compliance with organizational and regulatory guidelines. + Investigates providers… more
- UCLA Health (Los Angeles, CA)
- …be responsible for: + Managing the intake and resolution of member and provider appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid ... healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS guidelines and… more
- Intermountain Health (West Valley City, UT)
- …Revenue Integrity, Compliance , legal counsel, and RSC teams to prepare appeals . + Identifies trends and opportunities for denial prevention and collaborates with ... the appropriate multidisciplinary teams to improve denial management, documentation, and appeals process. + Supports legal counsel to prepare for Administrative Law… more
- LA Care Health Plan (Los Angeles, CA)
- …and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on ... Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department:...performance, trains, coaching, mentoring, motivating, and ensures compliance to policies, procedures and regulations. Ensures that… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- Shinda Management Corporation (Queens Village, NY)
- Compliance Specialist About the Organization For over three decades, SMC has been in the forefront of proven, quality real estate property management services in ... growth within the community by redefining affordable housing. Description SMC is seeking a Compliance Specialist to join our compliance department. Under the… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- State of Colorado (Denver, CO)
- DNR EDO Employee and Labor Relations Specialist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4715148) Apply DNR EDO Employee and Labor ... Relations Specialist II Salary $49,848.00 - $72,000.00 Annually Location Denver,...HRO ensures that human resources activities are administered in compliance with constitutional and statutory provisions as well as… more
- Schwan's Company (Gahanna, OH)
- …you can belong, contribute, and thrive, visit www.schwanscompany.com. This Safety & Compliance Specialist position is responsible, under limited supervision, to ... assist in the administration and implementation of moderate to complex safety compliance programs, policies and processes in an effort to achieve a workplace free of… more
- Amazon (Arlington, VA)
- …the world. Amazon is seeking an experienced Health & Welfare Operations Senior Specialist to join our Benefits Operations Services Team. This role will partner ... and bring issues to resolution. (50% of role) - Compliance Management: Collaborate with internal departments to resolve ...topics. Work with internal employee support teams to manage appeals and exceptions intake, review and determination. (5% of… more
