- RWJBarnabas Health (Oceanport, NJ)
- Associate Analyst ARS, Appeals , Remote, NJReq #:0000175741 Category:No Category Assigned Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate ... Crescent Place, Oceanport, NJ 07757 Summary of Job Function The Associate Analyst, Appeals is primarily responsible for validating clinical and technical denials… more
- Apex Health Solutions (Houston, TX)
- …is focused on the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints, process ... medical necessity, utilization management and claims appeals , initiate Independent Review Organization external reviews as well as respond to CMS and department of… more
- Apex Health Solutions (Houston, TX)
- …is focused on the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints, process ... medical necessity, utilization management and claims appeals , initiate Independent Review Organization external reviews as well as respond to CMS and department of… 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)
- …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
- 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 ... to achieve that purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the development of a successful… 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 Nurse Specialist LVN 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 Nurse Specialist LVN II is primarily responsible for the… 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)
- …and scanning incoming mail **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… 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 verbal ... and work collaboratively with CCA departments to help manage and resolve member appeals and grievances. * Act as a liaison between multiple departments to ensure… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all...indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to ... healthy living. JOB SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Humana (Indianapolis, IN)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… 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, US, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… more
- Geisinger (Danville, PA)
- Job Summary Provides support in administration of the Appeals and Grievance process. Serves as a liaison between Members and the Plan with appeals regarding ... and concerns regarding quality of care or service. PresentsMember appeals to the Plan Medical Staff and Center for...a combination of related work experience and degree obtained ( Associate 's Degree = 2 years; Bachelor's Degree = 4… more
- Humana (Columbus, OH)
- …caring community and help us put health first** The Supervisor, Grievances & Appeals is an inventory based role, supporting a team of associates assisting members ... This position will also support quality related go The Supervisor, Grievances & Appeals is an inventory based role, supporting a team of associates assisting members… more
- Healthfirst (AZ)
- …is Remote + Conduct quality audits of A&G items including grievances, pre-service appeals , and post service appeals utilizing appropriate sources of information; ... improve processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and… more
- HonorHealth (Scottsdale, AZ)
- …medical records documentation and billing statements on patient accounts; submits appeals to payers on patient account denials when appropriate; reviews medical ... appeal is clearly presented. Prioritizes and organizes own work to meet appeals and grievance deadlines. Responsible for the denials process, including subsequent… more