- Molina Healthcare (Tampa, FL)
- Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist . This position is remote and will be working Pacific Standard hours. Highly ... Qualified Candidates Will Have The Following Experience: + Strong understanding of UM, Appeals , and Medicare knowledge + Strong understanding of CMS regulations,… more
- Molina Healthcare (IA)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides support ... **Essential Job Duties** + Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers,… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist ...provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health… more
- Molina Healthcare (IA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to...subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and… more
- Cognizant (Lansing, MI)
- **Member 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 Member Appeals & Grievance Specialist with a minimum...with CMS Billing and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances , processes, resolutions, compliance TAT… more
- Molina Healthcare (Austin, TX)
- …and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. ... with the standards and requirements established by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal… more
- Molina Healthcare (Salt Lake City, UT)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... Act** cases in accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- CVS Health (Springfield, IL)
- …Integrated Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and ... within budgeted costs. **What you will do** + Acts as a top-level specialist on project management and develops a comprehensive plan that encompasses objectives,… more
- Cedars-Sinai (Beverly Hills, CA)
- …the payor + Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate ... + Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/ specialist as appropriate. + Coordinates the patient's care with other… more