- AmeriHealth Caritas (Philadelphia, PA)
- …us at www.amerihealthcaritas.com. **Summary:** Working with the Grievance Supervisor or Grievance Coordinator, the Grievance Associate ensures that all ... Federal, and State guidelines.;; **Responsibilities:** + Under the supervision of the Grievance Supervisor or Grievance Coordinator, act as a Member advocate… more
- Humana (Harrisburg, PA)
- …members and providers. As the Resolution Team Operations Director (Director, Grievance and Appeals), you will be accountable for the day-to-day operations ... and/or other end compliant inquiries. + Has 6-7 direct reports including Associate Directors, Managers, and Senior Professionals + Provides strategic direction and… more
- Fox Rothschild LLP (Philadelphia, PA)
- Labor & Employment Associate - Multiple Offices **Boston, MA; New York, NY; Philadelphia, PA, Washington, DC** **Description:** Fox Rothschild has an opening in ... multiple offices for a senior associate in our Labor & Employment Department. The ideal candidate will have five to seven years of traditional labor experience. We… more
- Humana (Harrisburg, PA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Humana (Harrisburg, PA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Humana (Harrisburg, PA)
- …comprehensive analytic review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then delivers final determination ... focused on continuously improving consumer experiences **Preferred Qualifications** + Associate 's or Bachelor's Degree + **Prior experience with Medicare** +… more
- Commonwealth of Pennsylvania (PA)
- …performing work in the areas of benefits or systems processing ; or + An associate 's degree and two years of experience in the processing of benefit payments ; or ... service purchases are calculated, clarification of information received, complaints, grievance settlements, arbitration awards, appeals, and tax information (ie… more
- Penn Medicine (Philadelphia, PA)
- …for Voluntary Treatment Form, HIPAA Acknowledgement of Receipt Form, Complaint & Grievance From, CBH Authorization to Release Info, Medical Eval, Psych Eval, and ... Credentials: + Basic Cardiac Life Support Education or Equivalent Experience: + Associate of Arts or Science (Required) + Sociology, social welfare, psychology,… more
- Humana (Harrisburg, PA)
- …be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more