- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the ... full life cycle of assigned member and/or provider appeals and grievance cases. Working under general...and regulatory processes preferred. Prior experience working with CMS, Medicaid , or state-regulated appeals processes preferred. +… more
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare Advantage, ... Medicare- Medicaid Program (MMP), and Medicaid lines of...+ Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center… 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 Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- …RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department:...as required. Perform other duties as assigned. Education Required Associate 's Degree in Nursing for Registered Nurses Education Preferred… more
- Humana (Lansing, MI)
- …call center or related customer service experience + 1 - 3 years of grievance and appeals experience + Previous experience processing medical claims + Bilingual ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- Humana (Washington, DC)
- …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 (Raleigh, NC)
- …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 (Carson City, NV)
- …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
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 2 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... and Plan Partners: Department of Health Services (DHS), Centers for Medicare and Medicaid Services (CMS) National Committee Quality Assurance (NCQA) as well as LA… 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