- Spectraforce Technologies Inc (Atlanta, GA)
- Job Title : Customer Service Representative/Customer Service Associate Representative Duration: 3+ Months Shift - must be available to work 8 hours, Monday-Sunday ... interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. Issues tend to be… more
- Blanchard Valley Health System (Findlay, OH)
- …of productivity to effectively reduce days in A/R. Develops and writes appeals for denials associated with the payment of claims within the department/division. ... Maintains appropriate timeliness of appeals for denials. Identifies other means and resources to...motion with intermittent bending, squatting, kneeling, and twisting. The associate must be able to sit for 3 hours,… more
- Penske Truck Leasing Co., LP (Reading, PA)
- …or manager with operating tax compliance processes including rendition/return filing, appeals and abatements and refund/bill entry. * Be able to understand ... or manager with operating tax compliance processes including rendition/return filing, appeals and abatements, bill entry for operating tax * Analyze processes,… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …verification result call. Welcome calls. Advanced alternate coverage research. Appeals /Denials. Intakes and reports adverse events as directed. Provides exceptional ... or similar vocations generally obtained through completion of a two-year associate degree program, technical vocational training, or equivalent combination of… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …process. Triages cases with missing information to appropriate program associate . Verifies patient specific benefits and precisely documents specifics for ... patient access. Could include documenting and initiating prior authorization process, claims appeals , etc. Completes quality review of work as part of finalizing… more
- US Tech Solutions, Inc. (Atlanta, GA)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc.). 10% . Identify and elevate clinical inquiries to the ... position. Education: . Verifiable High School diploma or GED is required. Associate Degree or Bachelor's Degree: If neither degree held, then equivalent years… more
- Compass Health Network (Sullivan, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... REQUIREMENTSAt least two (2) years of equivalent work experience required if an associate 's degree or medical assistant certification is not obtainedAt least two (2)… more
- CVS Health (Hartford, CT)
- …1+ years of Coding experience + Utilization Review experience + Medicare experience + Appeals experience Education + Associate RN Degree or RN Diploma required ... 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Harrisburg, PA)
- …to make health care more personal, convenient and affordable. Position Summary The Associate Manager will assist in the hiring and managing of the Medicare ... Complaints Team staff. The Associate Manager must possess outstanding people skills, exercise good judgement, and contribute to a team environment. Ability to build… more
- Universal Health Services (Richmond, VA)
- …or equivalent, Associate 's degree or higher preferred + 3-5 years appeals experience preferred + Strong Microsoft Office skills (Excel, Word, Outlook) + Ability ... Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist. The Senior Appeals Specialist is responsible for the resolution of all … more
- Magellan Health Services (San Diego, CA)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...Education - Required GED, High School Education - Preferred Associate License and Certifications - Required License and Certifications… 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 (Salem, OR)
- …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
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Wednesday, June 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)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… 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
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- Corewell Health (Grand Rapids, MI)
- …departments. Serves as a mentor/trainer to other team members. The Senior Appeals Analyst makes decisions on moderately complex issues regarding technical approach ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- CVS Health (Hartford, CT)
- …experience Appeals Experience Coding Experience Utilization Review experience Education Associate 's degree in nursing or higher Pay Range The typical pay range ... for this role are Monday-Friday 8a-5p. Position Summary The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician ... (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...least 3 years of experience in clinical setting. **Education:** Associate 's Degree in Nursing (ADN) required, Bachelor's of Science… more
