- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I...Supports the identification, investigation and resolve administrative complaints, simple appeals while adhering to Center for Medicare … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... 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 (Phoenix, AZ)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to...subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and… more
- Molina Healthcare (Fort Worth, TX)
- …+ 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
- Molina Healthcare (Macon, GA)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
- Molina Healthcare (Louisville, KY)
- …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
- J&J Family of Companies (Rogers, AR)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid ... Description:** We are searching for the best talent for Area Business Specialist , Neuroscience to cover the Oklahoma - Arkansas territory. **About Neuroscience** Our… more
- J&J Family of Companies (Cherry Hill, NJ)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid ... **Job Description:** We are searching for the best talent for Senior Area Business Specialist to be in South New Jersey. Territory includes: Cherry Hill, Toms River,… more
- J&J Family of Companies (Baltimore, MD)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid ... We are searching for the best talent for Neuroscience Area Business Specialist to be in Arlington, MD. **About Neuroscience** Our expertise in Innovative… more
- Molina Healthcare (Green Bay, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... timely and accurate processing of payment received.* Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation. * Must have… more
- State of Colorado (Pueblo, CO)
- …is rendered according to the State Board of Nursing (SBON), Centers for Medicare Services (CMS), The Joint Commission (TJC), Colorado Department of Public Health and ... nursing directives using effective communication. + Collaborates with the Clinical Safety Specialist (CSS) in the event of safety and security needs, to ensure… more
- State of Colorado (Pueblo, CO)
- …is rendered according to the State Board of Nursing (SBON), Centers for Medicare Services (CMS), The Joint Commission (TJC), Colorado Department of Public Health and ... nursing directives using effective communication. Collaborates with the Clinical Safety Specialist (CSS) supervisor in the event of safety and security needs,… more
- CVS Health (Carson City, NV)
- …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
- Actalent (Chattanooga, TN)
- …Job Responsibilities + Review and process medication-related prior authorizations, pharmacy appeals , and member grievances + Conduct prospective and ... Pharmacist - Coverage Review Specialist (Remote) Location: Must reside within 2 hours of Chattanooga, TN Work Environment: 100% Remote - Work From Home Employer:… more
- Cedars-Sinai (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