- Highmark Health (Columbus, OH)
- …of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... all involved parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross… more
- CVS Health (Columbus, OH)
- …each and every day. **Position Summary** Research and process grievances and appeals for Dual eligible members and providers. Perform outreach to obtain additional ... information. Interact with Medical Directors and Nurses as well as Leadership. **Required Qualifications** + 1 year of experience processing health insurance grievance and appeal cases. **Preferred Qualifications** + 2+ years of experience with Medicare and/or… more
- CVS Health (Columbus, OH)
- …matter and independently coaches others on matters regarding complaints and appeals , ensuring compliance with federal and/or state regulations. Ensures compliance ... audits. + Analyzes basic quality and completeness of the complaints and appeals documentation to ensure the accuracy, clarity, and compliance of the information… more
- Evolent (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple ... Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances) + Using analytical tools to integrate various data… more
- OhioHealth (Columbus, OH)
- …inquires. * This position has supervisory oversight of the Reimbursement Analyst daily work schedule including flow of information, teaching of reimbursement ... and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage...reporting 4 - 6 years as a Sr. Reimbursement Analyst or similar position(s). nt. **Work Shift:** Day **Scheduled… more