- VNS Health (Manhattan, NY)
- …is an exciting opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care ... Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance...processes. You will play a crucial role in overseeing staff interactions and ensuring that our members' voices are… more
- MyFlorida (Tallahassee, FL)
- …assistance cases are scheduled, hearings conducted, and decisions rendered by subordinate staff . The Appeals Referee Supervisor is required to have supervisory ... public and is responsible for addressing any public complaints concerning subordinate staff . The Appeals Referee Supervisor interprets policies, procedures, and… 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 ...+ Recommend solutions and works with department and company staff to ensure problems are corrected and departments are… more
- Corewell Health (Grand Rapids, MI)
- …appeals and grievances processes. + Supervise the day-to-day operations of the Appeals and Grievance staff and functions within the department ensuring ... Job Summary The Medicare Appeals Analyst Supervisor is responsible for managing, supporting, and oversight of the Appeals and Grievance team; this includes… 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 ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- University of Utah Health (Salt Lake City, UT)
- …is operated in accordance with applicable law. + Demonstrated understanding of insurance appeals and grievance processes. + Demonstrated experience in improving ... staff who process member and provider Grievance and Appeals . + Monitor and set goals for staff...equivalency. + Three years of experience in a health insurance environment, preferably in managed care appeals … more
- Elevance Health (Columbus, GA)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** _Elevance ... Medicaid Services to transform federal health programs. The **SCA Appeals Representative I** position is an entry-level position in...approve or summarize and route to nursing and/or medical staff for review. + The grievance and appeal work… more
- Elevance Health (Las Vegas, NV)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a remote model. Ideal candidates will live within 50 miles of one of our PulsePoint ... locations. The **Grievance/ Appeals Analyst I** is an entry level position in...approve or summarize and route to nursing and/or medical staff for review. + The grievance and appeal work… more
- Elevance Health (Wallingford, CT)
- **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...approve or summarize and route to nursing and/or medical staff for review. + The grievance and appeal work… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...Resolution as the liaison to members of the medical staff and other MO colleagues, regarding denial management processes,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …. Documents IRE responses on applicable systems. . Serves as a resource/training for appeals and grievances unit staff and as a resource for internal/external ... Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service, billing or related operations preferred. **Professional… more
- CVS Health (Salem, OR)
- …Management staff . * Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency. Provide after hours and weekend coverage ... this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C ...eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long… more
- Geisinger (Danville, PA)
- …and benefit issues and concerns regarding quality of care or service. PresentsMember appeals to the Plan Medical Staff and Center for Medicare/Medicaid Services ... Job Summary Provides support in administration of the Appeals and Grievance process. Serves as a liaison...limited to, health care providers, legal services, internal medical staff and administration. + Provides timely and accurate documentation… more
- New York State Civil Service (Melville, NY)
- NY HELP Yes Agency Insurance Fund, State Title Assistant Attorney 1/ Assistant Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) ... law, and case documents.* Communicate, discuss, and explain to Claims Department staff the basis for rejections of appeal requests;* Preparing and timely filing… more
- MTA (Brooklyn, NY)
- Deputy Executive Assistant General Counsel ( Appeals ) Job ID: 8104 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: ... Nov 27, 2024 Description Job Information Deputy Executive Assistant General Counsel ( Appeals ) Open Date: 7/11/2024 Close Date: Open Until Filled Authority: TA… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their respective auditors. Ensures the most accurate and descriptive… more
- CVS Health (Columbus, OH)
- …oversight for medical policy implementation. You will support the Medical Management staff ensuring timely and consistent responses to members and providers. As a ... cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited...eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long… more
- US Tech Solutions (Columbia, SC)
- …moved to work remote. Equipment will be provided. + Prefer 2 yrs. UM and/or appeals experience. We want to see all candidates with experience with prior insurance ... standards. Performs thorough research of the substance of service appeals by both member and provider based on clinical...Accreditation Commission (URAC). Knowledge of South Carolina Department of Insurance (SCDOI). Knowledge of US DOL and Health … more
- Community Health Systems (Fort Smith, AR)
- As a Remote Medical Denials / Appeals Specialist at Community Health Systems - Shared Services Center, you'll play a vital role in supporting our purpose to help ... serve. Our team members enjoy a robust benefits package including health insurance , flexible scheduling, 401k and student loan repayment programs. The Remote Medical… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals * Communicates clinical information to the payor, as needed, coordinating ... requiring Residential Health Care Facility placement. * Assist in having appropriate staff complete discharge forms in a timely manner. * Coordinates the Discharge… more