- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Molina Healthcare (New Haven, CT)
- …+ 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...of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals … more
- State of Colorado (Denver, CO)
- CDOC Community Program Specialist III (Treatment Coordinator Case Manager) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4947774) Apply CDOC ... Community Program Specialist III (Treatment Coordinator Case Manager) Salary $4,809.00 -...determining initial and/or continuing eligibility for the following programs: Medicaid , Long Term Care, Social Security Disability, Aid to… more
- Sutter Health (Sacramento, CA)
- …joining Sutter Health! **Organization:** SMF-Sutter Med Foundation- Central **Position Overview:** The Grievances & Appeals Specialist RN supports the ... causes of adverse events or near misses. Ability to manager patient grievances to protect patient rights, identify opportunities for improvement, and reduce… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake & Customer Service Specialist Department: Community Health & Research Center Location: Dearborn, MI START YOUR APPLICATION… more
- J&J Family of Companies (Philadelphia, PA)
- …(ie, eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid ... are searching for the best talent for Area Business Specialist to be in Philadelphia PA & surrounding suburbs....every step of the way. As the Area Business Specialist (ABS), you will: . Ensure appropriate identified new… more
- J&J Family of Companies (Nashville, TN)
- …(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 Area Business Specialist to be in Nashville TN. **About Immunology** Our expertise in Innovative… more
- City of New York (New York, NY)
- …with beneficiaries to answer questions and clarify Medicare Advantage plan specifics. Appeals and Grievances Support: - Assist beneficiaries in understanding ... older adults, community partners, and other groups on Medicare, Medicaid , Medigap, Elderly Pharmaceutical Insurance Coverage (EPIC), and Medicare's...to join our team as a Health Benefits Information Specialist . In this role, you will be tasked to… more
- Molina Healthcare (Everett, WA)
- …for claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances . * Coordinates with Corporate and Business ... regulatory requirements. * Monitors and reports network adequacy for Medicare and Medicaid services. * Develops strategies to improve EDI/MASS rates. * Educates and… more