- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… 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
- Transdev (Readville, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... (2) weeks + Sick days: 5 days + Holidays: 12 days; 9 standard and 3 floating + Other standard benefits: 401(k) retirement plan, medical, dental and vision, life… more
- Beth Israel Lahey Health (Westwood, MA)
- …manner. 2. Resolves all PBM related billing problems and issues. 3 . Handle phone inquiries and initial prescription intake. 4. Multidisciplinary responsibilities ... address information. Escalates calls to pharmacists for clinical inquiries and escalates grievances to supervisor. 7. Maintains new and existing patient profiles and… more
- Commonwealth Care Alliance (Boston, MA)
- …and supports, and community supports as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and ... medical, behavioral health, and social needs **Desired Experience (nice to have):** + 3 + years of minimum experience working in outreach or in the community caring… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... AHIMA or Medicaid billing-related certifications **Required Experience (must have):** + 3 + years in healthcare claims processing, provider reimbursement, or payment… more