- Healthfirst (NY)
- …degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case ... and Responsibilities: + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- University of Michigan (Ann Arbor, MI)
- Revenue Cycle Coding Supervisor - Appeals & Denials Apply Now **Job Summary** The Denial Coding Supervisor provides subject matter expertise in physician medical ... activities. This position oversees the Physician Billing (PB) Denial Coders and Appeals and Denial Coordinators, ensuring the accuracy and efficiency of denial… more
- Point32Health (MA)
- …are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Training Specialist is responsible for the development, ... of the various roles within Health Care Services, including utilization management and appeals and grievances to develop workflows, job aids, and policies. This… more
- BayCare Health System (Clearwater, FL)
- …and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company policies, ... and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure accurate… more
- Robert Half Accountemps (Durham, NC)
- …corporate medical policies and collaborate with Medical Directors for decisions regarding clinical appeals / grievances * Ensure quality, efficiency, and ... Description We are in search of an Intake Specialist to join our team. This role is...standards. Responsibilities: * Analyze and resolve confidential and sensitive appeals , grievances , and coverage/organization determinations from various… more
- State of Colorado (Lakewood, CO)
- Youth Services Specialist II - Rocky Mountain YSC in Lakewood Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4774176) Apply Youth Services ... Specialist II - Rocky Mountain YSC in Lakewood Salary...Recommends any modifications of the program to supervisory and/or clinical staff. Facilitates and monitors cleanup of pod and… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake & Customer Service Specialist Department: Community Health & Research Center Location:...are significant changes to the client history or other clinical issues that are presented) + Strong customer service… more
- Arab Community Center for Economic and Social Serv (Sterling Heights, MI)
- …to access services and rights processes - Assist with resolution of local complaints, grievances , and appeals processes - Survey, track, trend, and report on ... Intake and Customer Service Specialist Department: Community Health & Research Center Location:...are significant changes to the client history or other clinical issues that are presented) - Strong customer service… more
- Dignity Health (Bakersfield, CA)
- …manner to the health plan. - Partners as needed with the appeals and grievances functions of the department. **Qualifications** **Minimum Qualifications:** ... Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… more
- Henry Ford Health System (Detroit, MI)
- …Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals . + Demonstrated experience at a professional ... and compliance risks. + Provides instruction to department staff and clinical employees in correct documentation processes and coding guidelines. + Provides… more
- Point32Health (Canton, MA)
- …met + Track stakeholder feedback on product performance throughout the year, including Appeals & Grievances to help inform future benefit design guidance, ... timelines. The Senior Manager works closely with claims, membership operations, clinical services, care management, customer relations, sales, marketing, and other… more