- Novo Nordisk Inc. (Plainsboro, NJ)
- …Audits and Other Responsibilities Support and manage State tax inquires, audits and appeals . Identify, quantify, and report State tax risk for biannual internal tax ... A bachelor's degree required in accounting. CPA license or advanced degree strongly preferred A minimum of 5 years corporate tax experience either in public… more
- CareFirst (Baltimore, MD)
- …managed care, health care or insurance payor environment. 2 years experience in Appeals Management. ** Preferred Qualifications** : + College Degree + Knowledge ... Position will support government programs lines of business. The Appeals Specialist II will be responsible for the initial...II will be responsible for the initial analysis of appeals correspondence, and determination of next steps, with minimal… more
- Centene Corporation (Jefferson City, MO)
- …policies and standards **Registered Nurse with behavioral health and Medicare appeals experience preferred .** **Education/Experience:** Requires Graduate from an ... **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical… more
- Corewell Health (Grand Rapids, MI)
- …+ 1 year of relevant experience Health insurance/managed care experience performing Appeals and Grievances functions Preferred + Associate's Degree About ... Job Summary The Appeals intake coordinator position is focused on the...on the processing of incoming member and provider Medicare appeals and grievances. This team member will screen incoming… more
- University of Utah Health (Salt Lake City, UT)
- …experience in a health insurance environment, preferably in managed care appeals and grievances. **Qualifications ( Preferred )** **Working Conditions and Physical ... Supervise the day-to-day activities of staff who process member and provider Grievance and Appeals . + Monitor and set goals for staff workloads. + Ensure that staff… more
- CVS Health (Salem, OR)
- …Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly Preferred **Education** ... this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C ...Appeals : * Direct daily work on part C appeals (both provider and member/nonparticipating providers). * Provide direct… more
- WMCHealth (Valhalla, NY)
- …3-5 years as a Physician Reviewer/Advisor with a third party leveling and/or appeals agency preferred . Previous utilization management, case management or peer ... of the request. + Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with payors and/or complete appeals… more
- Cardinal Health (Columbus, OH)
- …documenting patient medical health insurance benefit investigations, prior authorizations, and appeals , preferred + Knowledge of Medicare, Medicaid and ... + Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… 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
- City of New York (New York, NY)
- …health and safety, and increasing opportunities for equitable growth. Your Team The Appeals Operations Coordinator will be a key member of the Division of ... of Compliance & Risk Management (CRM). The Division of Adjudications consists of the Appeals and the Mitchell-Lama Hearings Units. - The Appeals Unit conducts… 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
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los ... 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
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and ... appeals functions to include coordination of specific process and...or requested. Position Requirements: | Bachelor's Degree required; Master's preferred | Required to pursue ongoing education, certification and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating ... requires strong clinical and medical coding skills to review provider claim appeals for medical necessity, appropriate coding, and pricing of claims for payment.… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Officer** **Job Class: Revenue Tax Specialist Senior or Revenue Tax Specialist Principal** **Agency: Revenue Department** + **Job ID** : ... Agency/Seniority Unit** : Revenue Dept / Revenue (inc Assessors)-MAPE + **Division/Unit** : Appeals & Legal Services / Appeals 1 + **Work Shift/Work Hours**… more
- Elevance Health (Richmond, VA)
- **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...education and experience which would provide an equivalent background. ** Preferred Skills, Capabilities and Experiences** + Demonstrated business writing… more
- Point32Health (MA)
- …and communities. **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed entries ... from the Grievance and Appeals systems. Checks cases built by other associates to...Required (minimum): Bachelor's degree or equivalent business experience + Preferred : **Experience** + Required (minimum): 5 years or more… more
- CareFirst (Baltimore, MD)
- …position will support the government programs line of business. 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 applicable State and Federal… more
