- Cognizant (Juneau, AK)
- ** 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with...interactions and interventions into CCA database. Member Outreach: + Provide accurate, prompt, and courteous service in response to… more
- Molina Healthcare (Columbus, OH)
- …+ 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
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to… more
- Area Agency On Aging 1-b (Southfield, MI)
- … and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and accreditation ... and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and accreditation… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... goals through quality monitoring and training. This role partners directly with Appeals leadership to support on-going team development and growth. This role creates… more
- Actalent (Dallas, TX)
- Job Title: Specialist , Appeals & GrievancesJob Summary: Responsible for reviewing and resolving member and provider complaints and communicating resolutions. ... Key Responsibilities: + Conduct comprehensive research and resolve appeals , disputes, grievances , and complaints. + Use internal systems to determine outcomes of… 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: ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of… more
- Space and Naval Warfare Systems Command (Loma, ND)
- …on the technical aspects of personnel administration during formal hearings, grievances and appeals . Requirements Conditions of Employment Qualifications NO-04: ... Summary You will serve as an Administrative Specialist in the Human Resources Office of NAVWARSYSCEN...of NAVWARSYSCEN PACIFIC SAN DIEGO CA. Responsibilities You will provide Human Resources advisory services in the area of… more
- BayCare Health System (Clearwater, FL)
- …is completed and filed appropriately, and communicating effectively with all parties involved. + Provide reports on the status of grievances and provide ... updates to management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. +… more
- Independent Health (Buffalo, NY)
- …Director. This position will prepare written responses to appeals and complaints/ grievances , establish plans of correction and provide education to members ... responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing… more
- State of Colorado (Colorado Springs, CO)
- Youth Services Specialist II - Spring Creek Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5096121) Apply Youth ... Services Specialist II - Spring Creek Youth Services Center Salary...and parole. DYS is the agency statutorily mandated to provide for the care and supervision of youth committed… more
- LA Care Health Plan (Los Angeles, CA)
- … Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's… more
- TEKsystems (Honolulu, HI)
- Description Conducts critical analysis of highly complex and sensitive member and provider appeals , inquiries and grievances and applies internal policies ... and external resources and presents a full explanation of the member's or provider 's position and concerns to management and decision makers. Assists Supervisor and… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5096994) Apply Records ...Your score is based on the detailed information you provide on your application and in response to the… 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
- United States Fleet Forces Command (Naval Base, VA)
- …will resolve simple, informal employee complaints and refers complex issues (eg, grievances , appeals ) to the appropriate management or HR officials. Requirements ... Summary You will serve as a Lead Contract Specialist in the Data Business Systems Branch (C435)...helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to… more
- TEKsystems (Honolulu, HI)
- This job is fully in-person in Honolulu, HI Job Description + Manage appeals and grievances across all lines of business, including Medicare and Quest. + Address ... by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our… more
- Justice, Bureau of Prisons/Federal Prison System (Washington, DC)
- …Some examples of this qualifying experience are: GS-13: Experience investigating grievances submitted as administrative remedy appeals , regarding Women and ... and/or substitution of education), you will be required to provide an OFFICIAL transcript prior to your first day...the time of application. You may be required to provide proof of residence. Additional selections may be made… more