- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims or related managed care experience. Strong oral, written,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Supervision Exercised:** No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance and appeal ... pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- Baylor Scott & White Health (Temple, TX)
- …and/or level **Job Summary** **Hybrid position - limited time working onsite** The Appeals and Grievance Specialist reviews member and provider complaints, ... appeals , and grievance cases for all business lines. Responsibilities include timely classification and resolution of cases. They also review, research, and… more
- Elevance Health (Seattle, WA)
- **Manager II Grievance / Appeals (RN)** **Location** : **Hybrid 2:** This role requires associates to be in-office **3** days per week, fostering collaboration and ... be considered. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The **Manager II Grievance / Appeals ** is responsible for management oversight of grievances and… more
- CVS Health (Hartford, CT)
- …AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C ...Appeals . * Direct daily work on part C appeals (both provider and member/nonparticipating providers) * Provide direct… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC...Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... and evaluation by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the… more
- Molina Healthcare (Boise, ID)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... members and related outside agencies. + Review and evaluate appeal and grievance request to identify and classify member grievances, hand-off to appropriate… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Fallon Health (FH) Appeals and Grievance process is an essential function to FH compliance ... Appeals & Grievances Coordinator serves to administer the FH Appeals and Grievance process as outlined in the Member Handbook/Evidence of Coverage,… more
- Trinity Health (Columbus, OH)
- …financial analysis, audit, provider relations and more. **Position Purpose:** The Appeals and Grievance Coordinator is responsible for the processing and ... + Responsible for ensuring 5-Star (maximum) ratings from CMS for appeals and grievance related measures. STAR ratings have a direct correlation on payment… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...as a CCA content expert on State and Federal Grievance and Appeal regulations for all CCA products. +… more
- LA Care Health Plan (Los Angeles, CA)
- …Duties Responsible for providing ongoing training on the core processing system, Appeals and Grievance (A&G) processing procedures, training regulatory changes ... Customer Solution Center Appeals and Grievances Training Development Specialist III Job...III Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- CVS Health (Oklahoma City, OK)
- …of responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and ... report and recommend solutions. -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published business… more
- Commonwealth of Pennsylvania (PA)
- …you will also serve as a Grievance Review Officer, responsible for reviewing grievance appeals at the central office level. Your work will require conducting ... with other team members to plan, direct, and coordinated the management of the grievance system and related polices. If you have a passion for justice and strong… more
- CVS Health (Annapolis, MD)
- …ongoing provider in-services and provider education. + Participates, when requested, in Grievance and Appeals meetings, and/or assists with tracking and trending ... obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information… more
- Molina Healthcare (Jacksonville, FL)
- …procedures regarding compliance with local, state and federal guidelines. + Establishes member grievance appeals and policies and updates annually or as directed ... for Medicare and Medicaid Services. + Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the… more
- Humana (Dover, DE)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... billing of care received. May also engage in disputes and grievance and appeals reviews. May participate on project teams or organizational committees.… more
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