- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… 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 Angeles, CA, ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose....achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will… more
- Robert Half Accountemps (Los Angeles, CA)
- …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , will be in ... with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform...technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in… more
- Molina Healthcare (Omaha, NE)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member… more
- St. Luke's University Health Network (Allentown, PA)
- …AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... and apply appeal arguments and draft appeal letters to support and defend the codes assigned by the coding...with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents… more
- Elevance Health (Irving, TX)
- …our specialty pharmacies, our infusion centers, and the home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - ... weeks/30 days at the Plano, TX office. The **Referral Specialist II** is responsible for providing support ...necessary. + Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy. + Ability… more
- St. Luke's Health System (Twin Falls, ID)
- …place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist , is responsible for managing client medical denials by ... maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to departmental operating… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS diagnoses and/or procedures support the services/treatment rendered. JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- Kilgore College (Kilgore, TX)
- …physical risk. Safety: + Provide resources for safe operation of units. Create and support workplace safety. Benefits and Perks + 36-hour work week for a healthy ... work life balance as well generous paid leave time. + Health, life, and income protection insurance are provided. + An excellent retirement program through the Teacher Retirement System + Full Time employees have free use of the college's recreational/fitness… more
- State of Colorado (Denver, CO)
- …Description of Job WHAT YOU WILL DO This position provides administrative and legal support to the Criminal Appeals Section at the Colorado Attorney General's ... Administrative Assistant II (Criminal Appeals ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5023135) Apply Administrative Assistant II… more
- LA Care Health Plan (Los Angeles, CA)
- …template determination/education letters for members and providers. Duties Provide non-clinical support to the Customer Solution Center Appeals and Grievance ... Customer Solution Center Appeals and Grievances Coordinator I (Temporary) Job Category:...County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...works collaboratively with the AG Representatives and Management to support the development and maintenance of a quality program.… more
- Molina Healthcare (Midvale, UT)
- …the state of UTAH or have a compact license._ _This position will support our UT Medicaid & Marketplace Population. Excellent computer multi-tasking skills and good ... office with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
- Idaho Division of Human Resources (Boise, ID)
- …with other agencies, concerned parties, or sections within the Department regarding appeals /hearings processes. + Provide support to the Hearing Manager as ... COPP - Appeals /Hearings Technician Posting Begin Date: 2025/07/23 Posting End...Parole is currently accepting applications to fill a Hearing Specialist position. The successful candidate will be responsible for… more
- Hartford HealthCare (Farmington, CT)
- …of Connecticut's most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees ... other common practices across the system.*__* *_Position Summary:_* The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... denial management and appeals process, as applicable, in collaboration with clinical team...and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information utilizing various resources and… more
- MyFlorida (Tallahassee, FL)
- …will include, but are not limited to, the following: Member and Customer Support : + Level II Enrollment and Eligibility Appeals : performs research sufficient ... BENEFITS SPECIALIST - 72002680 Date: Jul 2, 2025 The...will be responsible for direct member and customer service support regarding eligibility and enrollment. This position is critical… more
- State of Arkansas (AR)
- …for manager, legal and appeals tribunal for hearings. Attend hearings and appeals related to each tax specialist 's 515 account. Research and remove any ... in establishing a relationship between claimant and employer to support a claimant's UI Claim. Conduct research to find...appeals tribunal for hearings. + Attend hearings and appeals related to each tax specialist 's 515… more
- Mount Sinai Health System (New York, NY)
- …work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more