- Daiichi Sankyo, Inc. (Boston, MA)
- …purpose of this role is to serve as a field-based product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient access ... of care on payer specific nuances related to utilization managements protocols and appeals Partner with DSI oncology field staff to ensure aligned customer approach.… more
- Daiichi Sankyo, Inc. (Seattle, WA)
- …purpose of this role is to serve as a field-based, product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient ... of care on payer specific nuances related to utilization managements protocols and appeals Partner with DSI oncology field staff to ensure aligned customer approach.… more
- Blanchard Valley Health System (Findlay, OH)
- PURPOSE OF THIS POSITION The Denial Management Specialist is responsible for the timely review and accurate identification and follow-up of all initial denial ... as the appeal of denials/rejections from third-party payers. The specialist will manage their assigned work relating to all...to effectively reduce days in A/R. Develops and writes appeals for denials associated with the payment of claims… 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 ... during the administrative hearing process. Works closely with the Compliance Officer and is an active member of the...communicate disposition of case . + Triages case inquiries, appeals , and prepares case files/packets for appeal hearings. Attend… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... as well as other internal and external partners to ensure a comprehensive appeals management process. Job Description Specialist II Key Outcomes: + Serves… more
- 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...judgment. This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS),… more
- Commonwealth Care Alliance (Boston, MA)
- …as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...Grievances team in a number of ways to ensure compliance on activities related to member complaints in the… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines. * Collaborates with managed care department… more
- Molina Healthcare (Georgetown, KY)
- …is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures (both ... APR-DRG, identify missed secondary diagnoses and procedures, PSIs, HACs and ensures compliance with all DRG mandates and reporting requirements. Analyzes reports and… more
- State of Colorado (CO)
- ECMC Enforcement Advisor ( COMPLIANCE SPECIALIST IV) -Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4633466) Apply ECMC ... Enforcement Advisor ( COMPLIANCE SPECIALIST IV) -Hybrid Salary $70,140.00 -...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... 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
- Shinda Management Corporation (Queens Village, NY)
- Compliance Specialist About the Organization For over three decades, SMC has been in the forefront of proven, quality real estate property management services in ... growth within the community by redefining affordable housing. Description SMC is seeking a Compliance Specialist to join our compliance department. Under the… more
- Amazon (Arlington, VA)
- …the world. Amazon is seeking an experienced Health & Welfare Operations Senior Specialist to join our Benefits Operations Services Team. This role will partner ... and bring issues to resolution. (50% of role) - Compliance Management: Collaborate with internal departments to resolve ...topics. Work with internal employee support teams to manage appeals and exceptions intake, review and determination. (5% of… more
- State of Indiana (Indianapolis, IN)
- Program Specialist Date Posted: Sep 6, 2024 Requisition ID: 449180 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career with the State of ... issue working across business units; Collaborates extensively with Contact Center, Adjudication, Appeals , Special Claims, TFA, Cashiering and BPC staff on a variety… more
- CareOregon (Portland, OR)
- …Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Benefit Specialist II Exemption Status Non-Exempt Department Pharmacy Manager Title Pharmacy ... include customer service, claims processing, prior authorizations, formulary exceptions, appeals , grievances, and project participation. Essential Responsibilities Customer Service… more
- State of Colorado (CO)
- ECMC Reclamation Specialist (EPS II) - Eastern Plains - Remote/Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4625817) Apply ECMC ... Reclamation Specialist (EPS II) - Eastern Plains - Remote/Hybrid Salary...purpose of this work unit is to e nsure compliance with the Colorado Energy and Carbon Management Commission… more
- LA Care Health Plan (Los Angeles, CA)
- …member grievances related to C&L Services to identify root causes. The C&L Specialist II completes activities to ensure compliance with regulatory and NCQA ... Cultural and Linguistic Services Specialist II Job Category: Clinical Department: Cultural &...partners, Specialty Plans, Ancillary Vendors, Participating Provider Groups (PPGs)) compliance with the regulatory and National Committee for Quality… more
- State of Colorado (Denver, CO)
- ECMC Location Assessment Specialist (EPS II) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4649055) Apply ECMC Location Assessment ... Specialist (EPS II) Salary $74,604.00 - $90,000.00 Annually Location...wellbores. Their review of hearing applications, in particular, ensures compliance with the 500-series Rules, and includes technical review… more
