- Chestnut Health Systems (Carlock, IL)
- …balances. Communicate with Utilization Review Coordinator regarding authorizations and appeals , documenting all communication in EHR. Respond to communication from ... assigned payers. Maintain an organized filing system. Function as a team member, supporting other team members as necessary. Qualifications Position requires a high school diploma or GED plus at least one year of experience in an office clerical or customer… more
- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator position is focused on the processing of customer and provider Medicare and Commercial appeals and grievances. ... incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent Review Organization external reviews as well as… more
- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator, Senior position, is focused on the processing of customer and provider Medicare and Commercial appeals and ... incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent Review Organization external reviews as well as… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for ... the activities and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of business. We are looking… 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
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- OAAS LT-PCS Appeals - Coordinator 1 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4677715) OAAS LT-PCS Appeals - Coordinator 1 Salary ... + Description + Benefits Minimum Qualifications Please clickHERE (https://ulsuno.wd1.myworkdayjobs.com/en-US/UniversityOfNewOrleans/job/Baton-Rouge-La/OAAS-LT-PCS- Appeals Coordinator-1\_R-001522-1?q=oaas) to apply. + Receive appeal notices… 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
- Point32Health (VA)
- …(https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… 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
- 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 ... 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
- 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily...is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA Care Health… more
- CareFirst (Baltimore, MD)
- …and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader ... 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 Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... 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
- Centene Corporation (Phoenix, AZ)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. ... verbal and written member and provider complaints, grievances and appeals + Prepare response letters for member and provider...response letters for member and provider complaints, grievances and appeals + Maintain files on individual appeals … more
- HCA Healthcare (Nashville, TN)
- …care like family! Jump-start your career as a Coding Operations Education and Appeals Consultant today with HCA Healthcare. The Coding Operations Education and ... Appeals Consultant is responsible for assisting in the efficient...all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group… more
- Elevance Health (Mason, OH)
- …Elevance Health location. **Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to grievances and ... appeals , manages inventory and production levels, and operational and...and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + Leads… 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
- UCLA Health (Los Angeles, CA)
- Description As the Senior Appeals and Grievances Analyst, you will be responsible for: + Assisting with all operational aspects of appeals and grievances, in ... state and federal regulations. + Assisting the unit Supervisor in overseeing the appeals and grievances process, ensuring that members and providers receive fair and… more
- City of New York (New York, NY)
- …services for administrative law judges and hearing officers. JOB DESCRIPTION: The OATH Appeals Division seeks an experienced attorney to serve as a full-time ... Appeals Officer. The Appeals Division reviews appeal requests and drafts appeal decisions relating to administrative hearings in which persons or businesses… 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
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