- Macpower Digital Assets Edge (Los Angeles, CA)
- Job Summary: The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across ... years experience in Healthcare Industry. Managed Care experience. ppeals & Grievances experience-preferably as Lead. 3 years experience designing and conducting… more
- Advanced Pain Care (Austin, TX)
- …letters Researches and evaluates insurance payments and correspondence for accuracy Logs appeals and grievances , and tracks progress of claims Keeps up-to-date ... will be fully remote after training. **Texas residents only Job purpose The Appeals Specialist is responsible for managing insurance denials by reviewing claims and… more
- Randstad (Worcester, MA)
- …Regulatory Compliance - Other Problem Solving Time Management Medical Records appeals grievances administrative support Qualifications Years of experience: 2 ... This role is responsible for triaging and assigning all incoming appeals and grievances and will also provide administrative support to the department. salary:… more
- The City University of New York (New York, NY)
- …Rules); tracking student conduct reports; coordinating the student conduct process, grievances , and appeals . Oversee the Faculty Student Disciplinary Committee ... process, early intervention student support service process, the resolution of student grievances , appeals , and complaints, and the utilization of the Behavioral… more
- Elevance Health (Grand Prairie, TX)
- …Law Enforcement). Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. Minimum Requirements: Requires BA/BS degree ... and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. Specific education, years, and type of experience may be required based upon state law and… more
- Molina Healthcare (Long Beach, CA)
- …reviews and recommends corrective actions. Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... for medical necessity. Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of… more
- UHS (Riverside, CA)
- …Bachelor's preferred. Minimum 3 years' experience in Medical Management (Utilization Management, Appeals and Grievances , and/or Concurrent Review). Over 2 years ... of experience in a health plan or healthcare auditing, compliance and/or operations. Awareness and experience with HIPAA requirements for healthcare communications preferred. Familiarity with developing and implementing auditing and monitoring processes across… more
- Premier Administrative Solutions (Clearwater, FL)
- …client trust. *Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... in Product Development and Sales processes, including participation when requested in prospective client presentations, regulatory reviews and contracting of vendors. Primary Performance Expectations: Performance review for the Claims Manager is ongoing, with… more
- NORTH EAST MEDICAL SERVICES (San Francisco, CA)
- …including participation in regional or national geriatric societies. Reviews all appeals and grievances . Coordinates quality assurance activities including the ... development, implementation, and ongoing evaluation of a quality assurance plan for the program. Provides information and conduct presentations regarding the PACE program as required Participates in the Quality Improvement Committee, Ethics Committee, and… more
- Veracity Solutions (Kennewick, WA)
- …problems, such as: working conditions, disciplinary actions, and employee and applicant appeals and grievances , according to circumstances, and provides guidance ... and recommendations for problem resolution to departmental officials and individuals. *Prepares and presents required and special reports. *Develops and presents the operating budget for the Human Resources Dept. and, upon final budget approval, assures that… more
- CenCal Health (Santa Barbara, CA)
- …management functions; assists subordinate managers in resolving medical claims review, grievances , appeals , and other medical management issues Works closely ... concurrent (hospital/ skilled nursing facility) and retro authorizations, and appeals ; approves/denies or offers medical alternatives according to CenCal Health… more
- UnitedHealth Group (Eugene, OR)
- …and resolve provider, physician, organization and/or member feedback, complaints, and grievances . Serve as primary resource to senior management, plan sponsors, ... and Oregon in resolution of oral and written complaints, feedback and appeals . Responsible for researching and resolving written, phone and internet complaints and… more
- CAPPS (Austin, TX)
- …trends relating to the nutrition and food services program; investigates youth grievances , as needed; and develops and assists with developing responses to grievance ... appeals and alleged mistreatments related to dietary and nutrition services. Collaborates with departmental staff in meeting established objectives and goals; shares… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and ... audit findings and identifies areas of opportunity for the A&G ( Appeals and Grievances ) department. Understands department, segment, organizational strategy… more
- Molina Healthcare (St. Petersburg, FL)
- …apply state level requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with ... and interprets trends and prepares reports that identify root causes for Appeals , Grievances , and Provider Disputes. Recommends and implements process… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
- Molina Healthcare (San Antonio, TX)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving...monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Accounting/Finance Department: CSC Appeals & Grievances ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the… more
- Point32Health (Watertown, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
