- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... role will work identify root causes of issues and provide real time solutions for members that have a...failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately… more
- Molina Healthcare (Omaha, NE)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… more
- Molina Healthcare (Doral, FL)
- …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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- Centene Corporation (Nashville, TN)
- …reporting and directories as well as claims payment resolution as it relates to provider set up. Provide support to external provider representatives to ... division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point… more
- TEKsystems (Honolulu, HI)
- …and determine the best course of action. + Analyze sensitive member and provider appeals , inquiries, and grievances , applying internal policies, contractual ... We are seeking a Customer Support Specialist to join a leading healthcare organization. This...critical in supporting members and providers by handling inquiries, appeals , and grievances with professionalism and accuracy.… more
- State of Colorado (Denver, CO)
- CDOC Community Programs Specialist III (Re-Entry) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5190353) Apply CDOC Community Programs ... Specialist III (Re-Entry) Salary $4,906.00 - $7,849.00 Monthly Location...re-entry needs of individuals, develop and implement transitional plans, provide case management to parolees to set goals and… more
- Molina Healthcare (WI)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... of Member Materials. **Knowledge/Skills/Abilities** * Maintains confidential telephone line to provide direct assistance to Members and/or family members who are… more
- J&J Family of Companies (Cherry Hill, NJ)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid rules and ... searching for the best talent for Senior Area Business Specialist to be in South New Jersey. Territory includes:...the optimal site of care for the patient and provider . + Approach each customer from a total account… more
- ManpowerGroup (Alexandria, MN)
- …matters to appropriate departments when necessary. + Identify issues related to grievances or appeals and follow proper procedures accordingly. **What's ... leading organization in healthcare services, is seeking a **Transportation Contact Center Specialist ** to join their team. As a Transportation Contact Center … more
- FLACRA (Clifton Springs, NY)
- …closely with Managed Care insurance providers to understand their policies, including grievances and appeals , and assist clients with advocacy as needed. ... Utilization Management Specialist FLACRA Clifton Springs, NY (Onsite) Full-Time $16.50...list. + Manage workflow efficiently with minimal interruptions. + Provide crisis management and referral services as necessary. +… more
- Government Publishing Office (Washington, DC)
- …of data. Resolves simple, informal complaints of employees and refers formal grievances and appeals to the appropriate official. Requirements Conditions of ... a diverse array of talent in many administrative fields and trades. We provide other agencies with innovative services for the printing, publishing, storage, and… more
- Navy Federal Credit Union (Pensacola, FL)
- Overview To provide guidance to management and employees on performance concerns, conflict resolution, organizational changes, HR policies and procedures, ... improvement efforts, investigations, policy interpretation and resolution of employee grievances /charges. Responsibilities + Evaluate employee inquiries and problems to… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- State of Colorado (Pueblo, CO)
- …century, Colorado Mental Health Hospital in Pueblo (CMHHIP) is a leading employer, provider of quality mental health services, and community partner. CMHHIP is a 24 ... behavioral health acute care facility that is intended to provide a safe, secure, and therapeutic setting for patients...+ Addresses patient complaints/complaints of family and resolves patient grievances at the unit level. + Aware of patient… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... policy clarification; makes on-site visits to program sites to provide face-to-face HR availability to employees in the work...Relations Specialist or Senior Manager of Employee Relations as required… more
- State of Colorado (Sterling, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and creates real life ... included as part of your application materials. Failure to provide a transcript or credential evaluation report may prevent...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …Orders and ensuring completion of mandatory annual training. + Resolving informal grievances This position may participate in the Duty Officer rotation; is subject ... to details and follow instruction + Determination to follow policy and provide efficient, effective service while utilizing state resources responsibly + Ability to… more
- Cedars-Sinai (Beverly Hills, CA)
- …to match the payor + Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements ... + Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/ specialist as appropriate. + Coordinates the patient's care with other… more
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