- Molina Healthcare (Bothell, WA)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… 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 ... in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member… more
- 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 ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… 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
- BayCare Health System (Park Lake, KY)
- …responsibility 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… more
- TEKsystems (Honolulu, HI)
- …This role is critical in supporting members and providers by handling inquiries, appeals , and grievances with professionalism and accuracy. You will work closely ... the best course of action. + Analyze sensitive member and provider appeals , inquiries, and grievances , applying internal policies, contractual provisions, and… 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 ... Employment Qualifications To qualify for the Lead Printing Services Specialist , PG-1654-13, you must meet the following requirements: Individual Occupational… 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 ... **Job Description:** We are searching for the best talent for Senior Area Business Specialist to be in South New Jersey. Territory includes: Cherry Hill, Toms River,… 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 - $17.50/Hour Apply Now… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
- Centene Corporation (Nashville, TN)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... of contact and liaison between assigned providers and the health plan. + Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues. + Act as department subject matter expert. +… more
- Molina Healthcare (Milwaukee, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... team to resolve eligibility issues affecting premium billing. * Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor. * Reconcile unallocated payments on a daily basis. * Resolve orphan member payments on a… 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
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... Relations Specialist or Senior Manager of Employee Relations as required...with 20+% dedicated time committed to handling employee complaints, grievances , interactive processes, and disciplinary actions. + Familiarity with… more
- State of Colorado (Pueblo, CO)
- …after hours. + Addresses patient complaints/complaints of family and resolves patient grievances at the unit level. + Aware of patient allergies, sensitivities of ... Demonstrates understanding of the role of the Patient Right Specialist and utilizes this person as a resource when...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Sterling, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and creates real life ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange, at doc_###@state.co.us or call ###. ALL… more
- State of Colorado (Denver, CO)
- …Orders and ensuring completion of mandatory annual training. + Resolving informal grievances This position may participate in the Duty Officer rotation; is subject ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange, at doc_###@state.co.us or call ### .… more
- The Cigna Group (Salem, OR)
- …Complete onsite quality assessments + Respond to provider inquiries, concerns, complaints, appeals and grievances + Provide ongoing product education to dentists ... procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial… more
- Cedars-Sinai (Beverly Hills, CA)
- …the payor + Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate ... + Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/ specialist as appropriate. + Coordinates the patient's care with other… more