- LA Care Health Plan (Los Angeles, CA)
- …Education Preferred Experience Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in ... Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department:...(Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by… more
- Office of Personnel Management (Washington, DC)
- … insurance-related matters; b) Assisting individuals with technical and complex health insurance appeals ; c) Researching, analyzing and developing responses ... complex or unusual health benefits-related customer service inquiries and/or health insurance appeals ; d) Reviewing healthcare records to resolve… more
- Elevance Health (Woburn, MA)
- **Grievance/ Appeals Representative II** **Location:** Hybrid 500 Unicorn Park Drive Woburn, MA The **Grievance/ Appeals Representative II** is responsible ... an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. + Contacts customers… more
- Magellan Health Services (Boise, ID)
- …team directly contacts candidates should there be a fit. If you suspect you are being contacted by a false representative of Magellan Health , please call ### ... Coordinates appeals process as assigned, attends to risk management...Responsibilities Experience in customer interactions and detailed review of health related materials. Strong interpersonal skills and attention to… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4477399) Apply Appeals Referee Salary $74,191.00 - $112,666.00 Annually ... of Labor & Industry, Unemployment Compensation Board of Review is seeking an Appeals Referee for our Harrisburg office. In this position, you will hear and… more
- Point32Health (Canton, MA)
- **Who We Are** Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our ... the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care,...Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and… more
- MyFlorida (Orlando, FL)
- 828166 -OPS EMPLOYMENT SECURITY REP II - 40099083 1 1 1 1 Date: Apr 25, 2024 Location: ORLANDO, FL, US, 32809 The State Personnel System is an E-Verify employer. For ... 828166 Agency: Commerce Working Title: 828166 -OPS EMPLOYMENT SECURITY REP II - 40099083 1 1 1 1 Position...are not available for this position) OPS Employment Security Representative II This position will be used for multiple… more
- MyFlorida (Fort Lauderdale, FL)
- 828269 - OPS EMPLOYMENT SECURITY REP II - 40099086 1 1 1 1 1 1 Date: Apr 26, 2024 Location: FT LAUDERDALE, FL, US, 33311 The State Personnel System is an E-Verify ... Agency: Commerce Working Title: 828269 - OPS EMPLOYMENT SECURITY REP II - 40099086 1 1 1 1 1...are not available for this position) OPS Employment Security Representative II This position will be used for multiple… more
- MyFlorida (Tallahassee, FL)
- 828113 - OPS EMPLOYMENT SECURITY REP II - 40099084 1 1 1 1 1 Date: Apr 24, 2024 Location: TALLAHASSEE, FL, US, 32308 The State Personnel System is an E-Verify ... Agency: Commerce Working Title: 828113 - OPS EMPLOYMENT SECURITY REP II - 40099084 1 1 1 1 1...are not available for this position) OPS Employment Security Representative II This position will be used for multiple… more
- Carle (Urbana, IL)
- Rev Cycle Regional Rep 2 + Department: Revenue Cycle - CFH_10_19 + Entity: Peoria Service Area + Job Category: Clerical/Admin + Employment Type: Full - Time + Job ... Save Save Apply Now Position Summary: Proficient in Revenue Cycle Regional Representative 1. Responsible for handling escalated account and payer issues. Handles… more
- Elevance Health (Wichita, KS)
- **Network Relations Consultant, LTSS Provider Representative ** **Location:** Kansas. This position will work a hybrid model (remote and office). The ideal candidate ... will live within 50 miles of one of our Kansas Elevance Health PulsePoint locations. The **Network Relations Consultant, LTSS Provider Representative ** develops… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, April 29, 2024 Centers Plan for Healthy Living's goal is to ... Reviewer will handle expedited and standard requests and ensures that the appeals are processed in accordance with regulations, compliance standards and policy and… more
- Universal Health Services (Riverside, CA)
- …each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations ... and or mail out all assigned tracer claims 3. Initiate claims review or appeals , as indicated on assigned explanation of benefits. 4. Review, adjust and/or process… more
- Universal Health Services (Riverside, CA)
- …each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations ... errors, missing information, and billing discrepancies. + Prepare and submit appeals for denied claims, utilizing a comprehensive understanding of payer requirements… more
- State of Indiana (Indianapolis, IN)
- Appeals Operations Director Date Posted: Apr 25, 2024 Requisition ID: 442811 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career with ... a welcoming, accessible, and equitable workplace with a workforce that is representative of Indiana's population. As a proud equal opportunity employer, reasonable… more
- Corewell Health (Stevensville, MI)
- …support in complex matters to assist in the delivery of quality health care services. Essential Functions + Responsible for complex patient/customer problem solving, ... that prior authorization has been obtained; assists with retroactive insurance denials/ appeals . + Responsible for complex EMR/EHR scanning and Right Fax faxing… more
- University of Rochester (Rochester, NY)
- …information from the electronic medical record. Is accountable for planning, execution, appeals and efficient follow through on all aspects of the process which ... staffing to assist with overcoming any identified barriers or social determinants of health . Other duties as assigned **QUALIFICATIONS:** + High School Diploma and a… more
- Universal Health Services (Riverside, CA)
- …projects. 8. Coordinate CPPI (California Physician Performance Initiative). 9. Review/respond to health plan or individual grievances and appeals in a timely ... the best place to work, practice medicine, and receive care. SUMMARY: Prepare Health Plan required reports, Action plans from audits (CAPs), medical record audits,… more
- Intermountain Health (Broomfield, CO)
- …resolve complex issues in a timely and accurate manner. Scope As a Patient Account Rep II you need to know how to: Review insurance aging reports- Resubmit and work ... corrected claims and appeals - Review and manage aging claims and accounts receivable, as well as comprehensive follow up to maximize reimbursement . Minimum… more
- MyFlorida (Orlando, FL)
- 828309 - EMPLOYMENT SECURITY REPRESENTATIVE II - 40046050 Date: May 1, 2024 Location: ORLANDO, FL, US, 32809 The State Personnel System is an E-Verify employer. For ... 828309 Agency: Commerce Working Title: 828309 - EMPLOYMENT SECURITY REPRESENTATIVE II - 40046050 Pay Plan: Career Service Position...from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission.… more