- VNS Health (Manhattan, NY)
- …issues pertaining to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense ... + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance and Appeals… more
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure ... pharmacy, dental, reporting, and member services. * Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- LA Care Health Plan (Los Angeles, CA)
- …meet and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing ... assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… 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...is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA… more
- BayCare Health System (Clearwater, FL)
- …be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary… 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, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... areas to implement those changes. **Responsibilities** . Reviews and evaluates appeal/ grievance requests and electronic inquiries in order to identify and classify… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeal & Grievance Specialist , you will be responsible for: + Managing the intake and resolution of member and provider appeals and ... + Working closely with medical director and appeal & grievance team to ensure that all cases are handled...operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... grievance process that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
- Maryland Department of Transportation (Baltimore City County, MD)
- Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually Location Baltimore City Job Type Full Time Job Number ... + Benefits + Questions Description MARYLAND TRANSIT ADMINISTRATION Labor Relations Specialist (Administrator III) (2588) Grade 18 Career Service Open to all… more
- Henry Ford Health System (Grand Blanc, MI)
- …facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within ... active participation in the negotiations of collective bargaining agreements, manage grievance procedures to handle complaints from unionized employees, and advise… more
- State of Massachusetts (Norfolk, MA)
- …ensuring accuracy of information to be transferred to the database; Enter grievance and disciplinary appeals as directed; conduct CJIS background checks ... given to those applicants that apply within the first 14 days.* Office Support Specialist I: Applicants must have at least (A) two years of full-time, or equivalent… more
- Transportation Security Administration (Nashville, TN)
- …technical aspects of the work directed (employee relations principles and practices, appeals and grievance processes, OWCP, position management, staffing, human ... for people and commerce. Responsibilities This Supervisory Human Resources Specialist position is located Nashville International Airport (BNA), Transportation… more
- Missouri State University (Springfield, MO)
- Posting Details Position Information Position Title Administrative Specialist II (McQueary College of Health and Human Services) Work Location Springfield Campus ... Type Full Time Regular Exempt/Non-Exempt Non-Exempt General Function The Administrative Specialist II works in depth with programs, processes, or services that… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- State of Colorado (Denver, CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Ana Andersen at doc_###@state.co.us or call ### ALL… more
- Geisinger (Danville, PA)
- …billing, and reimbursement. + Completes clinical reviews related to Claims, Claim Edits, Appeals and the Grievance process, assisting in analysis of clinical ... 2 years; Bachelor's Degree = 4 years). Certification requirement: CPC-Certified Coding Specialist through AAPC or CCS- Certified Coding Specialist through AHIMA… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more
- Elevance Health (Los Angeles, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... medical specialty required. **Preferred skills, capabilities, and experiences:** + Oncology specialist preferred + Internal medicine specialist preferred **For… more