- Apex Health Solutions (Houston, TX)
- …may screen incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent Review Organization external ... diploma and two years in a managed care environment performing in appeals review /investigation function will be considered. License/certification: None One year… more
- Elevance Health (Woodland Hills, CA)
- …for employment. **Grievances and Appeals Analyst I** + Job Family: CLM > Claims Support + Type: Full time + Date Posted:Apr 17, 2024 + Anticipated End Date:May ... and indemnity) related to clinical and non clinical services, quality of service, and quality of care...Minimum of 3 years experience working in grievances and appeals , claims , or customer service; or any… more
- Elevance Health (Norfolk, VA)
- …consideration for employment. **Grievance/ Appeals Analyst I** + Job Family: CLM > Claims Support + Type: Full time + Date Posted:Apr 16, 2024 + Anticipated End ... and indemnity) related to clinical and non clinical services, quality of service, and quality of care...Minimum of 3 years experience working in grievances and appeals , claims , or customer service; or any… more
- LA Care Health Plan (Los Angeles, CA)
- …etc. Collaborates with internal departments (Member Services, Provider Network Operations, Claims , Utilization Management, Pharmacy, and Quality Management) to ... and State Fair Hearing files for compliance with Policies and Procedures and directives. Review and monitor procedures for identifying quality of care issues and… more
- Point32Health (Canton, MA)
- …provides oversight for the day-to-day act ivies of the complex operations of the Appeals and Grievance Department. + Monitor quality and production standards by ... Plan benefits. + Oversee Appeals and Grievances CMS star performance + Develop, review , revise and monitor policies and procedures to ensure that all work of the… more
- Universal Health Services (Reno, NV)
- …the Appeals Specialist is responsible for ensuring the appropriate review , research, processing and responding to written member and provider complaints, ... appeals , and grievances. This position is required to apply...English, both verbally and in writing. + Understanding of claims payment and utilization management process. + Excellent organizational,… more
- LA Care Health Plan (Los Angeles, CA)
- …and provider complaint and appeals issues, including eligibility, access to care, claims , benefit, and quality of care concerns. Experience working with firm ... This position reviews pre-service authorizations, concurrent and post-service (retroactive review ) medical necessity; benefit coverage appeals and… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …may be assigned at any time with or without notice. Primary Responsibilities + Thorough review of claims and medical documentation. + Prepare cases for clinical ... review . + Advanced claim processing including professional, facility and...claims . + Provide accurate and timely responses to appeals , grievances and all other correspondence. + Communicate effectively… more
- State of Colorado (Denver, CO)
- Assistant Attorney General (Criminal Appeals ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4481411) Apply Assistant Attorney General ... (Criminal Appeals ) Salary $83,292.00 - $120,000.00 Annually Location Denver, CO...record, conducting legal research on all of the defendant's claims , and crafting responsive arguments to explain why a… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily… more
- UCLA Health (Los Angeles, CA)
- …to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned ... to the auditor. You will review claims (paid, pending, and denied) for...and procedures. You will: * Research over and under-payment inquiries/ appeals * Compile and maintain statistical data consistent *… more
- Serco (Washington, DC)
- …and CHIP eligibility error rate and improper payments. + Oversee medical and claims review staffing, training, quality assurance, production, IT systems ... Serco is seekinga motivated Assistant Program Director for Medical Claims Review to join our talented and... policies, processes, operations, error rate analysis, findings and appeals . + Serve as the primary point of contact… more
- LA Care Health Plan (Los Angeles, CA)
- …internal review of proposed legislation impacting the adjudication of claims , (3) and collaborates/participates in all aspects of compliance impacting the ... Claims Compliance Data Validation Analyst II Job Category:...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- Billings Clinic (Billings, MT)
- …coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance ... agencies by reviewing errors and other prebilling insurance reports/worklists. Analyzes and review claims to ensure that payer specific regulations and… more
- Federal Highway Administration (Lakewood, CO)
- …and is a technical expert on construction means and methods in the defense of claims and trial appeals . The ideal candidate should be a technical expert in ... is head of Central Federal Lands Highway Division's (CFLHD's) Construction Branch Claim Review Section. The person in this position is a technical expert in highway… more
- Veterans Benefits Administration (Indianapolis, IN)
- Summary The Veterans Service Representative (Authorization Quality Review Specialist) is an integral part of the VSC quality assurance program and is a key ... the Pension and Fiduciary Service and the Court of Appeals for Veterans Claims are met or...GS-12: To qualify for the Veterans Service Representative (Authorization Quality Review Specialist), GS-0996-12 position, applicants must… more
- Medical Mutual of Ohio (OH)
- …on member experience. . Administers daily oversight processes including daily reject review , paid claims , transition supply oversight, Part D coverage ... with a strong focus on member experience. . Coordinates pharmacy reject review and resolution either directly or forwards/escalates to other departments or PBM.… more
- CareOregon (Portland, OR)
- …Pharmacy Technician Certification. Core responsibilities include customer service, claims processing, prior authorizations, formulary exceptions, appeals , ... and provider appeals & reconsiderations, gather data & documentation and prepare appeals for review by CareOregon Pharmacists & Medical Directors. + Complete… more
- HCA Healthcare (Brentwood, TN)
- …want to join an organization that invests in you as a Clinical Denials Coding Review Specialist? At Work from Home, you come first. HCA Healthcare has committed up ... We are looking for a dedicated Clinical Denials Coding Review Specialist like you to be a part of...researching, analyzing, and resolving outstanding clinical denials and insurance claims . This job requires regular outreach to payors and… more
- HCA Healthcare (Brentwood, TN)
- …you want to join an organization that invests in you as a Denial Coding Review Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 ... difference. We are looking for a dedicated Denial Coding Review Specialist like you to be a part of...researching, analyzing, and resolving outstanding clinical denials and insurance claims . What you will do in this role: +… more