- Fallon Health (Worcester, MA)
- …information, visit fallonhealth.org. **Brief Summary of Purpose:** Fallon Health's (FH) Appeals and Grievance process is an essential function to FH's compliance ... other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH … more
- VNS Health (Manhattan, NY)
- …including intake, classification, setup, and assignment of grievances and appeals . Additionally, provides administrative support to staff, including tasks such ... as clinical case file preparation for appeals . This includes retrieving documents from related systems (such...Do + Identifies case types (eg- clinical vs non-clinical appeals ) during the intake process, communicates and responds to… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members ... the activities and serves as a resource for associates within the Clinical Appeals and Analysis unit. **ESSENTIAL FUNCTIONS:** + Provides direct supervision for the… more
- Point32Health (Canton, MA)
- …colleagues and communities. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Robert Half Accountemps (Houston, TX)
- Description Job Description: Billing Appeals Specialist (Short-Term Contract) Position Overview: Our client, a prominent legal firm, is seeking a Billing Appeals ... in reviewing denied billing claims, analyzing discrepancies, and filing appeals to ensure accurate and timely payments are received....errors in invoicing or reimbursement. + Prepare and Submit Appeals : Draft detailed and accurate appeals for… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH … more
- Equitable (Charlotte, NC)
- Appeals Specialist, Disability Claims ( 25000066 ) **Primary Location** : UNITED STATES-NC-Charlotte **Other Locations** : UNITED STATES-Remote, UNITED ... will help unlock your potential? Equitable is seeking an influential and dynamic Appeals Specialist to join our Disability and Absence Claims organization. The … more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and ... appeals functions to include coordination of specific process and...Responsibilities: | Prepares necessary documentation for utilization management and appeals processes, performs data management and coordinates communication between… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to...I primary function is to learn the specialty level appeals and grievances work supporting the higher level position… 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
- Equitable (Charlotte, NC)
- Appeals and Complaints Team Leader, Disability and Absence Claims ( 25000055 ) **Primary Location** : UNITED STATES-NC-Charlotte **Other Locations** : UNITED ... will help unlock your potential? Equitable is seeking an influential and dynamic Appeals and Complaints Team Leader to join our Disability and Absence Claims… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- CenterLight Health System (NY)
- JOB PURPOSE: The Claim Appeals and Audit Specialist will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by timely and ... accurate processing of claims appeals and performing claims audit, ensuring payment integrity and...State, CMS, and contractual guidelines. This position emphasizes the appeals review and auditing of claims to drive process… more
- CVS Health (Harrisburg, PA)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. * Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. *… more
- R1 RCM (Detroit, MI)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor** , you will help support clinicians who conduct a ... comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation,… more
- Elevance Health (Tampa, FL)
- **Grievance/ Appeals Analyst Lead** **Candidates must be located within 50 miles an Elevance Health PulsePoint office. This position is primarily work from home but ... to work in the office quarterly.** **Schedule: Monday-Friday 8am-5pm EST** The **Grievance/ Appeals Analyst Lead** is responsible for leading and coaching a team of… more
- R1 RCM (Salt Lake City, UT)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Supervisor** , you will support clinical coders and coding team ... conduct a comprehensive review of coding denials and formulate appeals based on documentation and/or make coding change suggestions...what you will experience working as a Clinical Coding Appeals Supervisor:** + Track daily inventory of cases and… more
- State of Massachusetts (Boston, MA)
- …with taxpayers on problem cases. *Position Summary* The function of the Office of Appeals is to hear tax disputes in an informal, expeditious and consistent manner, ... to the correct amount of tax that should be paid. Appeals Officers review and analyze taxpayer appeals ,...be paid. Appeals Officers review and analyze taxpayer appeals , conduct conferences and hearings, and negotiate settlements. Interns… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... business need) Unrestricted RN licensure **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied… more
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