- Harbor Health Services, Inc. (Mattapan, MA)
- …key process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist , maintains oversight of the ... and consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist . Requirements: Bachelor's Degree… more
- Molina Healthcare (San Antonio, TX)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service 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… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… more
- Healthfirst (FL)
- …outreach through dismissal and complete verbal outreach attempts** + **Analyze incoming appeals and grievances to determine eligibility for dismissal based on ... or GED from an accredited institution + Work experience with appeals and grievances or healthcare environment + Work experience requiring verbal and written… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- Washington Headquarters Services (Alexandria, VA)
- …related to: adverse and disciplinary actions associated with conduct, dispute resolution, grievances , Merit Systems Protection Board (MSPB) appeals , or Office of ... Incumbent typical work assignments may include the following: Serving as a senior specialist within the LMER division providing a full range of advisory services,… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5151510) Apply Records Specialist 1 Salary $40,685.00 - $60,714.00… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ ... Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,...subscriber certificates and apply to the investigation of member grievances . + Manage the fair hearing process for cases… more
- ManpowerGroup (Alexandria, MN)
- …matters to appropriate departments when necessary. + Identify issues related to grievances or appeals and follow proper procedures accordingly. **What's ... in healthcare services, is seeking a **Transportation Contact Center Specialist ** to join their team. As a Transportation Contact...to join their team. As a Transportation Contact Center Specialist , you will be part of the Member &… more
- J&J Family of Companies (Jackson, MS)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid rules and ... States **Job Description:** We are searching for the best talent for Area Business Specialist , Neuroscience to be in the Jackson, MS territory which includes all of… more
- J&J Family of Companies (Denver, CO)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid rules and ... We are searching for the best talent for Neuroscience Area Business Specialist to cover the territory of Colorado-Wyoming. **About Neuroscience** Our expertise in… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
- Centene Corporation (Columbus, OH)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... of contact and liaison between assigned providers and the health plan. + Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues. + Act as department subject matter expert. +… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... resolve reimbursement concerns. + Conduct retrospective audits to identify systemic payment issues and recommend resolution pathways. + Interpret and apply MassHealth fee schedules, All-Payer Rate Setting regulations, and CMS payment methodologies (eg, DRG,… more
- Molina Healthcare (Green Bay, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... team to resolve eligibility issues affecting premium billing. * Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor. * Reconcile unallocated payments on a daily basis. * Resolve orphan member payments on a… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- Molina Healthcare (NE)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- State of Colorado (Denver, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness, and creates real life ... and water treatment plant; position also assists the HVAC specialist with the repair and maintenance of all climate...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
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