- CVS Health (Frankfort, KY)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of ... case load including but not limited to: -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published… more
- Humana (Frankfort, KY)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Humana (Frankfort, KY)
- …not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic ... and other reference sources. Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and will understand how to… more
- Humana (Frankfort, KY)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... of business, member population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on project teams or organizational… more
- Humana (Frankfort, KY)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... and other reference sources. Medical Directors will learn Medicare, Medicaid , and Medicare Advantage requirements and will understand how...and care received. May also engage in disputes and grievance and appeals reviews. May participate on… more
- BrightSpring Health Services (Bowling Green, KY)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct individual… more