- Humana (Columbus, OH)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
- Fallon Health (Worcester, MA)
- **Overview** **The Member Appeals and Grievances Intake Administrator is working M - F 8 am to 5 pm in the office 5 days/week. We are looking for someone that is ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and… more
- CareFirst (Baltimore, MD)
- …health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances . **Preferred Qualifications:** + Applicants with specific ... experience in Medicare and / or Medicaid appeals are...the interdependencies between Medical Policy, Clinical Medical Review and Appeals and Grievances . + Ability to mentor… more
- Healthfirst (IA)
- …Triage and assign expedited appeals while helping standardize and optimize how Appeals and Grievances are routed + Manage inventory to ensure regulatory ... meet production, compliance and quality targets to perform all Appeals & Grievances tasks + Build partnerships...several computer applications such as Microsoft Word and Excel, corporate email and virtual filing systems (ie. Macess), and… more
- Highmark Health (Charleston, WV)
- …them to assure ongoing relationships with the corporation maximize their effectiveness. + Grievances and Appeals - Assist in the evaluation and resolution of ... works closely with all divisions and departments within the corporate structure to provide clinical consultation and support with... grievances and appeals of patients, providers, and… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently...such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess). Experience… more