• Medical Director - Medicare Appeals

    CVS Health (Salem, OR)
    …home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff *… more
    CVS Health (11/02/24)
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  • Appeals and Grievances Analyst

    UCLA Health (Los Angeles, CA)
    …deadlines effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. + Collaborates closely with beneficiaries, healthcare ... addressed in a timely manner. + Analyze and process appeals and grievances in accordance with CMS/ Medicare ...process appeals and grievances in accordance with CMS/ Medicare regulations and guidelines. + Investigate complaints and work… more
    UCLA Health (11/15/24)
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  • Appeals and Grievances Analyst

    UCLA Health (Los Angeles, CA)
    …deadlines effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. + Collaborates closely with beneficiaries, healthcare ... addressed in a timely manner. + Analyze and process appeals and grievances in accordance with CMS/ Medicare ...process appeals and grievances in accordance with CMS/ Medicare regulations and guidelines. + Investigate complaints and work… more
    UCLA Health (11/15/24)
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  • Sr Appeals Specialist

    Medical Mutual of Ohio (Brooklyn, OH)
    …issues and submit cases to appropriate area for review. . Facilitates processing of Medicare appeals to the independent review entity (IRE) . Documents IRE ... experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare ...an Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service, billing or related… more
    Medical Mutual of Ohio (11/14/24)
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  • Medicare Grievances and Appeals

    Humana (Columbus, OH)
    …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
    Humana (10/29/24)
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  • Appeals and Grievances Coordinator

    Apex Health Solutions (Houston, TX)
    …Grievances coordinator position 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… more
    Apex Health Solutions (11/15/24)
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  • Senior Appeals and Grievances Coordinator

    Apex Health Solutions (Houston, TX)
    …coordinator, Senior position, 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… more
    Apex Health Solutions (11/15/24)
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  • Audit & Reimbursement Senior- Appeals

    Elevance Health (Columbus, OH)
    …Services to transform federal health programs. The **Audit and Reimbursement Senior- Appeals ** will support our Medicare Administrative Contract (MAC) with ... supervisory review of cost report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + PRRB Hearings +… more
    Elevance Health (11/16/24)
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  • Specialist, Grievance and Appeals

    VNS Health (Manhattan, NY)
    …state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully Integrated Dual Advantage (FIDA) and… more
    VNS Health (10/25/24)
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  • Medicare Billing Collections Specialist…

    CVS Health (Monroeville, PA)
    …opportunity also provides free parking. **What you will do** + Timely response to Medicare audits and appeals + Research and gather the appropriate documentation ... to form all levels of appeals for Medicare + Third party follow-up associated with the dispensing g of prescription medication via telephone, Internet, and in… more
    CVS Health (10/26/24)
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  • Patient Account Representative - Healthcare…

    Guidehouse (Lewisville, TX)
    …(Manager, Talent Acquisition) at ###_** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer ... + 1+ year's medical provider experience working with UB04, appeals & denials. **What Would Be Nice To Have**...Would Be Nice To Have** **:** + Has active Medicare appeal process experience + PC skills in a… more
    Guidehouse (10/07/24)
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  • Appeals & Grievances Specialist

    UCLA Health (Los Angeles, CA)
    …2 or more years of experience in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * ... guidelines and working with regulatory requirements, preferred * Strong knowledge of Medicare Advantage plans, CMS regulations, and the appeals and grievances… more
    UCLA Health (10/31/24)
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  • Medicare Pharmacy Coordinator

    Medical Mutual of Ohio (OH)
    …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances, and Medicare marketing material requirements. . Assists ... new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances, and Medicare marketing material requirements. . Assists… more
    Medical Mutual of Ohio (09/20/24)
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  • Prior Authorization Specialist

    US Tech Solutions (RI)
    …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
    US Tech Solutions (11/07/24)
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  • Representative I

    US Tech Solutions (May, OK)
    …volume where needed. **Responsibilities:** Utilizing multiple software systems to complete Medicare appeals case reviews Meeting or exceeding government mandated ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
    US Tech Solutions (10/18/24)
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  • Prior Authorization Specialist

    US Tech Solutions (May, OK)
    …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
    US Tech Solutions (10/18/24)
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  • Grievances & Appeals Representative 3

    Humana (Indianapolis, IN)
    …compassionately interact with geriatric population **Additional Information** + This role supports Medicare Advantage (MA) Part C Expedited Appeals **Work at ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...and speak English and Spanish + Prior experience with Medicare + Experience with the Clinical Guidance Exchange, CGX… more
    Humana (11/20/24)
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  • Appeals & Grievances Nurse

    UCLA Health (Los Angeles, CA)
    …skills, particularly in evaluating medical necessity * Thorough understanding of Medicare Advantage regulations, especially related to appeals , grievances, and ... Description As the Appeals & Grievances Nurse, you will play a...of medical care and services rendered in relation to Medicare guidelines, compliance requirements, and internal policies. + Identifying… more
    UCLA Health (10/31/24)
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  • Coordinator-RAC TPE - HS Revenue Audit Corporate

    Baptist Memorial (Memphis, TN)
    Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare /Medicaid Appeals Process. Familiarity of billing regulations including federal and… more
    Baptist Memorial (09/05/24)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    …clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. ... prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals .… more
    Mohawk Valley Health System (09/18/24)
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