- 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 ... role will work identify root causes of issues and provide real time solutions for members that have a...failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately… more
- Molina Healthcare (Omaha, NE)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… more
- Molina Healthcare (Doral, FL)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- TEKsystems (Honolulu, HI)
- …and determine the best course of action. + Analyze sensitive member and provider appeals , inquiries, and grievances , applying internal policies, contractual ... We are seeking a Customer Support Specialist to join a leading healthcare organization. This...critical in supporting members and providers by handling inquiries, appeals , and grievances with professionalism and accuracy.… more
- State of Colorado (Denver, CO)
- CDOC Community Programs Specialist III (Re-Entry) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5190353) Apply CDOC Community Programs ... Specialist III (Re-Entry) Salary $4,906.00 - $7,849.00 Monthly Location...re-entry needs of individuals, develop and implement transitional plans, provide case management to parolees to set goals and… more
- Molina Healthcare (Madison, WI)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... of Member Materials. **Knowledge/Skills/Abilities** * Maintains confidential telephone line to provide direct assistance to Members and/or family members who are… more
- J&J Family of Companies (Cherry Hill, NJ)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid rules and ... searching for the best talent for Senior Area Business Specialist to be in South New Jersey. Territory includes:...the optimal site of care for the patient and provider . + Approach each customer from a total account… more
- ManpowerGroup (Alexandria, MN)
- …matters to appropriate departments when necessary. + Identify issues related to grievances or appeals and follow proper procedures accordingly. **What's ... leading organization in healthcare services, is seeking a **Transportation Contact Center Specialist ** to join their team. As a Transportation Contact Center … more
- FLACRA (Clifton Springs, NY)
- …closely with Managed Care insurance providers to understand their policies, including grievances and appeals , and assist clients with advocacy as needed. ... Utilization Management Specialist FLACRA Clifton Springs, NY (Onsite) Full-Time $16.50...list. + Manage workflow efficiently with minimal interruptions. + Provide crisis management and referral services as necessary. +… more
- Government Publishing Office (Washington, DC)
- …of data. Resolves simple, informal complaints of employees and refers formal grievances and appeals to the appropriate official. Requirements Conditions of ... a diverse array of talent in many administrative fields and trades. We provide other agencies with innovative services for the printing, publishing, storage, and… more
- Insight Global (San Francisco, CA)
- …to change - thrives in a fast-moving, start-up environment Experience with grievances , appeals , or quality assurance within healthcare operations Background in ... Job Description Insight Global is seeking a Remote Operations Support Specialist to join our clients growing Food Operations team. This role supports the day-to-day… more
- Navy Federal Credit Union (Winchester, VA)
- Overview To provide guidance to management and employees on performance concerns, conflict resolution, organizational changes, HR policies and procedures, ... improvement efforts, investigations, policy interpretation and resolution of employee grievances /charges. Responsibilities + Evaluate employee inquiries and problems to… more
- LA Care Health Plan (Los Angeles, CA)
- …Analytics Required: Experience analyzing call center operations, enrollment services, and appeals & grievances . Experience translating data into actionable ... Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's… 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
- LA Care Health Plan (Los Angeles, CA)
- …Analytics Required: Experience analyzing call center operations, enrollment services, and appeals & grievances . Experience translating data into actionable ... Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's… more
- LA Care Health Plan (Los Angeles, CA)
- …Analytics Required: Experience analyzing call center operations, enrollment services, and appeals & grievances . Experience translating data into actionable ... Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's… more
- State of Colorado (Denver, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... Resources The Division of Human Resources (HR) exists to provide human resource services to the general public, applicants,...retention; selection and selection appeals ; settlement advice; strategic planning and overall HR guidance… more
- Molina Healthcare (Omaha, NE)
- …for claims payment); Provider /Member Inquiry Research and Resolution; and Provider /Member Appeals and Grievances . * Coordinates with Corporate ... **Job Description** **Job Summary** Molina's Provider Contracting function provides guidance, signature support services,...providers who: * Are aligned with our mission to provide quality health services to financially vulnerable families and… more
- State of Colorado (Pueblo, CO)
- …century, Colorado Mental Health Hospital in Pueblo (CMHHIP) is a leading employer, provider of quality mental health services, and community partner. CMHHIP is a 24 ... behavioral health acute care facility that is intended to provide a safe, secure, and therapeutic setting for patients...+ Addresses patient complaints/complaints of family and resolves patient grievances at the unit level. + Aware of patient… more
Related Job Searches:
Appeals,
Appeals Grievances,
Grievances,
Provider,
Specialist,
Specialist Appeals Grievances