- EmblemHealth (New York, NY)
- …Position Perform clinical and administrative reviews within the Grievance and Appeals department, ensuring accurate administration of benefits, execution of clinical ... appropriate clinical setting, and as a clinical resource to the non-clinical Appeals staff. Enter and maintain documentation in the appropriate workflow tools… more
- United Nations (New York, NY)
- …* Monitors issues on conditions of service of staff and advises the supervisor of any developments and the work of the human resources assistants/HR partners. ... Assists in providing documentation and background materials relating to classification appeals . General * Assists in providing documentation and background materials… more
- PacificSource (Springfield, OR)
- …physical, behavioral, and oral health utilization management, and grievance and appeals . As appropriate, interface with appropriate regulatory agencies to influence ... Management departments and activities. As assigned, participate in relevant Manager/ Supervisor meetings including meetings related to Population health, Provider… more
- Steward Health Care (Dallas, TX)
- …timelines. The Revenue Cycle Associate reports to the central business office supervisor or manager. Meets goals and objectives in assigned area; Complies daily ... a timely and compliant manner; Researches, prepares, and submits appeals to insurance companies; Details all actions taken on...and/or issues that may be trends and escalate to supervisor as needed; and Maintain strict confidentiality and adhere… more
- Merced County Office of Education (Merced, CA)
- …the fiscal oversight of each school district in Merced County, hears appeals for student expulsion hearings and interdistrict transfers and operates Green Meadows ... Outdoor School. Job Summary Under general supervision of a Site Supervisor or Master Teacher, teach an assigned group of students using developmentally appropriate… more
- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …evidence-based medical decision-making. Review and approve prior authorization requests, appeals , and other medical determinations in alignment with regulatory ... and resolving problems. Performs other job duties as required by manager/ supervisor . Qualifications QUALIFICATIONS: Education: MD or DO degree with an active… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor , Appeals and Grievances ... and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals and Grievances Department and… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor ** , you will help support clinicians who ... this remote position. **Here's what you will experience working as a Clinical Appeals Supervisor :** + Track and monitor the workflow of the clinical team daily… more
- Point32Health (Watertown, MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... 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
- 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...Federal and State Regulations. Complete individual summary scorecards for Supervisor feedback. + Track monthly scores on spreadsheet and… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- Penske (Reading, PA)
- …audits, including negotiating with auditors and interfacing with taxing jurisdictions. -Perfect appeals and refund claims. -The position will require the ability to ... vendors and related companies -Other projects and tasks as assigned by supervisor **Qualifications:** -2 years of tax experience preferred -A Bachelor's degree is… more
- Robert Half Finance & Accounting (Asheville, NC)
- Description We are looking for a skilled Billing Supervisor /Manager to oversee medical billing processes and ensure the accuracy and efficiency of claims management ... a dedicated and detail-oriented individual with expertise in medical billing, appeals handling, and insurance claims management. The ideal candidate will bring… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …informal complaints of employees and referring others, such as formal grievances and appeals to the supervisor or an appropriate management official. Uses a ... direction relating to the telehealth program. Works with the supervisor to develop assignments for team members in order...status and progress of work to ensure that the supervisor 's instructions on work priorities, methods, deadlines, and quality… more
- State of Colorado (Golden, CO)
- CORRECTIONAL, YOUTH, SUPERVISOR III at CALM Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5014202) Apply CORRECTIONAL, YOUTH, SUPERVISOR ... regards to Critical Incidents + Assists and oversees Shift Supervisor duties + Ensures staff are assigned to appropriate...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Canon City, CO)
- CDOC Housekeeping Supervisor CSTS I (Canon City) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5018245) Apply CDOC Housekeeping ... Supervisor CSTS I (Canon City) Salary $5,031.00 - $7,043.00...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Colorado Springs, CO)
- Kitchen Supervisor - Correctional Support Trades Supervisor II - Spring Creek Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019161) Apply ... Kitchen Supervisor - Correctional Support Trades Supervisor II...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Canon City, CO)
- CDOC General Maintenance Supervisor CSTS I (Canon City) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5018302) Apply CDOC General ... Maintenance Supervisor CSTS I (Canon City) Salary $5,031.00 - $7,043.00...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- Correctional Youth Security Supervisor III - Pueblo Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5016924) Apply ... Correctional Youth Security Supervisor III - Pueblo Youth Services Center Salary $2,601.69...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
