- Centene Corporation (Phoenix, AZ)
- …individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data entry, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Elevance Health (Columbus, OH)
- …Services to transform federal health programs. The **Audit and Reimbursement Senior- Appeals ** will support our Medicare Administrative Contract (MAC) with ... **Audit & Reimbursement Senior- Appeals ** _This is a United States based, virtual...and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …+ Advanced degree. + Minimum 1 year of professional experience in health care field, appeals , or LTC program support . + Minimum 1 year of professional experience ... OAAS LT-PCS Appeals - Coordinator 1 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4677715) OAAS LT-PCS Appeals - Coordinator 1 Salary… more
- CVS Health (Salem, OR)
- …Review nurses Provide after hours and weekend coverage on a rotational basis to support 24/7 appeals work * IRE monitoring and tracking and Utilization ... what we deliver. Our Heart At Work Behaviors (TM) support this purpose. We want everyone who works at...of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C … more
- R1 RCM (Boise, ID)
- …policy to recommend appropriate actions. + Apply clinical judgment to support medical necessity appeals reviewing against appropriate coverage guidelines. ... AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse** , you will help our hospital clients...our hospital clients by serving as an expert on appeals and denials management where claims were denied by… more
- UCLA Health (Los Angeles, CA)
- …of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals . Leverage your expertise to support UCLA Health's commitment to ... accuracy and quality in claim processing. As an Audit and Appeals Specialist, you will: + Facilitate responses to regulatory audits related to billing, coding, and… more
- Board of Veterans Appeals (District Of Columbia, DC)
- …is located within the Department of Veterans Affairs (VA), Board of Veterans' Appeals (Board), Office of Appellate Support in Washington, DC Responsibilities ... to recommend the integration and optimization of the Board of Veterans' Appeals automated systems. Develops short and long-range plans covering projects, initiating… more
- Colorado State University (Fort Collins, CO)
- …Student Eligibility to coordinate completing all verification, data resolution, and professional judgment appeals + Provide support as necessary to all areas of ... as the primary resource for issues related to professional judgment appeals and provides timely support to office staff so that they may quickly and effectively… more
- IQVIA (Phoenix, AZ)
- …companies for benefit investigation and coverage eligibility + Provide prior authorizations and appeals support + Assist patients with the enrollment process for ... and/or providers to evaluate eligibility for assistance programs and/or varied adherence support . This is a **remote** position. **Hours:** **Must be available for… more
- Amentum (Washington, DC)
- …SMO team, Amentum leadership, and staff collaboratively Oversee and ensure operational support services are delivered to VCF Appeals /Hearings components and ... Deputy Special Master and DOJ Attorney Team Leads regarding Appeals /Hearings operations and/or issues. + Oversee and support... Appeals /Hearings operations and/or issues. + Oversee and support 2 Amentum Appeals /Hearings staff to ensure… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with local case ... management leadership. This individual will support the pursuit of excellence in care coordination, discharge planning, resource stewardship, and regulatory… more
- VNS Health (Manhattan, NY)
- …+ Ensures the accuracy and integrity of data collection and reporting systems to support analysis and reporting of grievances and appeals data for operations and ... Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance...(RN)to lead the daily operations of our grievance and appeals processes. You will play a crucial role in… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose....purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance/ Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- CareFirst (Baltimore, MD)
- …the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance departmental capabilities. Accountable… 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, CA, ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Customer… 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, US, ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Customer… more
- Ally Pediatric Therapy (Chandler, AZ)
- …when necessary. - Collaborate with clinical staff to provide documentation supporting appeals . Patient & Family Support : - Assist families with understanding ... families to ensure accurate and timely billing, optimize revenue, and provide support to families navigating the complexities of insurance coverage for autism… more
- City of New York (New York, NY)
- …Center for Creative Conflict Resolution which provides mediation and restorative justice support to City government agencies and the general public, and the ... a resource center that provides training, continuing education, research and support services for administrative law judges and hearing officers. JOB DESCRIPTION:… more