- Cognizant (Boston, MA)
- ** Provider Appeals & Grievances Specialist ** (remote) This is a remote position open to any qualified applicant that lives in the United States. ... **Summary:** We are seeking a dedicated Provider Appeals & Grievance Specialist ...directly with CMS Billing and Coding-Medical Insurance Knowledge of Member/ Provider Appeals and Grievances , processes,… more
- Molina Healthcare (Boston, MA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Cognizant (Boston, MA)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Commonwealth Care Alliance (Boston, MA)
- …issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and resolve ... Medicare, and commercial payment methodologies and supports audit, compliance, and provider engagement initiatives. This role also provides support in managing … more