- 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services… 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
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... challenged. Responsible for enterprise wide outpatient clinical review and appeals on Medicare and Medicaid RAC, PERM,...clinical review and appeals on Medicare and Medicaid RAC, PERM, CERTs, etc. audits. Assists account representatives… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible for providing comprehensive responses in compliance with contract, regulatory and accreditation requirements ... experience in an administrative clinical setting, including 1-2 years medicaid managed care appeals process & Health/Human Services. + The ability to effectively… more
- Insight Global (Los Angeles, CA)
- Job Description The Customer Solution Center Appeals and Grievances Specialist I will support the Appeals and Grievances team to receive, investigate and ... resolve member and provider complaints and appeals ; escalate complex issues or questions to leadership team...appeals while adhering to Center for Medicare and Medicaid Services (CMS), California Department of Health Care Services… more
- Molina Healthcare (Georgetown, KY)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- UNC Health Care (Goldsboro, NC)
- …the health and well-being of the unique communities we serve. Summary: The Medicaid Eligibility Specialist screens, coordinates and facilitates the Medicaid ... who meet the eligibility criteria. Obtains eligibility for patients entitled to Medicaid for the purpose of obtaining reimbursement for services provided by Wayne… more
- CommuniCare Health Services Corporate (Richmond, VA)
- Regional Medicaid Specialist , Virginia Communicare Health Services is currently recruiting a dynamic individual with prior Business Office or Admissions ... in Long Term Care for the position of Regional Medicaid Specialist for our facilities located in...+ Escalate difficult cases to management timely + File appeals with the appropriate agency when necessary + Build… more
- Bear Mountain Health Care (MA)
- …Home Medicaid EXPERT? Bear Mountain Healthcare is currently seeking a full time Medicaid Pending Specialist to assist in the completion of Medicaid ... facilities in Massachusetts. Duties include: . Responsible for working Pending Medicaid applications and re-determinations in order to ensure financial eligibility.… more
- State of Colorado (Denver, CO)
- Medicaid Fraud Investigator (Special Agent III) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4627371) Apply Medicaid Fraud Investigator ... is seeking an experienced investigator to join the Colorado Medicaid Fraud Control Unit ("COMFCU"). The COMFCU is crucial...application will be reviewed by a qualified Human Resources Specialist to determine if you meet the minimum qualifications… more
- HCA Healthcare (Nashville, TN)
- …Unlock your potential! **Job Summary and Qualifications** The Clinical Review Specialist is responsible for performing retrospective medical reviews based on patient ... a retrospective review of medical records using clinical expertise and Medicaid guidelines to determine medical necessity for emergent inpatient admissions and… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- … Medicaid eligibility. + Minimum 2 years of professional experience working with Medicaid appeals process. + Advanced knowledge of the LaMEDS system. + ... CAU Eligibility Specialist Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4574616) CAU Eligibility Specialist Salary Depends on… more
- BeneLynk (Sunrise, FL)
- …our employees to thrive in their ability to assist others. Government Relations Specialist POSITION SUMMARY The GR Specialist is responsible for engaging ... federal, state and county Medicaid agencies to advocate on behalf of members and...get the benefits to which they are entitled. The specialist directly supports the Vice President of Government Relations… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and benefit plans including: + Competitive Pay + Medical, Dental, Vision ... Team, and Atmosphere! We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ teams in Massachusetts. The Clinical Reimbursement… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The Utilization Review Specialist (LVN) is responsible for completion and ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews,...Medicaid (CMS) and healthplan requirements. The Utilization Review Specialist (LVN) will serve as liaison and primary point… more
- Prime Therapeutics (Columbus, OH)
- …drives every decision we make. **Job Posting Title** Maximum Allowable Cost Programs Specialist - Remote **Job Description Summary** The purpose of this position is ... pharmacy reimbursement, provides liaison services between enrolled providers and the Medicaid departments, and supports providers during the enhancement of the… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract** **Job Description:** + Prior Authorization Specialist ... and/or resolve coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. + Must maintain… more
- The New Jewish Home (Bronx, NY)
- …Finance Department in Waters Place, Bronx is seeking a full time Managed Care Billing Specialist to join our team. The Managed Care Specialist is responsible for ... create project spreadsheets for submission to payers, write reconsideration appeals and send to MCOs, and be able to...billing is required + Must Understand Medicare, Managed Care, Medicaid (NY) billing and reimbursement + Prior experience working… more
- LA Care Health Plan (Los Angeles, CA)
- …Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- El Paso County (Colorado Springs, CO)
- Benefit Eligibility Associate & Specialist Print (https://www.governmentjobs.com/careers/elpasocountyco/jobs/newprint/4652058) Apply Benefit Eligibility Associate ... & Specialist Salary See Position Description Location Colorado Springs, CO...as Adult Financial assistance, Long Term Care, SNAP, and Medicaid . In this position, you would rotate with other… more