- Staffing Solutions Organization (Albany, NY)
- …clarification of policies and procedures which may include marketing, enrollment, grievances and appeals , provider/plan education, and quality monitoring ... is a reflection of our clients and the people they serve. **Healthcare Data Specialist 1 in Albany, NY** **Division of Health Plan Contracting & Oversight (DHPCO)… more
- Molina Healthcare (Everett, WA)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals 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 ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Molina Healthcare (AZ)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member… more
- Molina Healthcare (GA)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… more
- Molina Healthcare (AZ)
- …* At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. * ... and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- Intermountain Health (Des Moines, IA)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... Intermountain Health in OIG hearings and 1st level grievances with insurance companies and CMS. This position communicates regularly with various levels of internal… more
- US Marine Corps (Quantico, VA)
- …investigations and leave administration. Performs and reviews trend analysis of grievances , unfair labor practices, complaints, and appeals , and develops ... be considered in effecting disciplinary actions, removals, suspensions, and in resolving grievances and appeals related to formal disciplinary actions taken and… more
- Tufts Medicine (Boston, MA)
- …research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to ... role may delegate and oversee the work of the Employee & Labor Relations Specialist . This position requires deep knowledge of both employment and labor laws (eg,… more
- Office of Administration (Washington, DC)
- …which includes: (1) Reviewing regulations and administrative instructions pertaining to grievances , appeals , and reasonable accommodation requests; (2) Advising ... Officer (OCAO), Employee Relations Branch. The incumbent serves as a journeyman specialist , performing the lead role for employee relations and the performance… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 - SCI Fayette Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5140166) Apply Records Specialist 1 - SCI Fayette… more
- Salt Lake County (Salt Lake City, UT)
- …utilizing objective jail classification principles. + Respond to detainee requests, grievances , and appeals . KNOWLEDGE, SKILLS, AND ABILITIES (KSA) Knowledge ... Job Description Judicial Processing Specialist $42,250.00 - $58,380.00 DOE** +$1 per hour...correctional facility until their time of release. Judicial Processing Specialist provides a critical service within the Criminal Justice… more
- J&J Family of Companies (Rogers, AR)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid rules and ... 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)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid rules and ... **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)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid rules and ... We are searching for the best talent for Neuroscience Area Business Specialist to be in Arlington, MD. **About Neuroscience** Our expertise in Innovative… more
- Insight Global (San Francisco, CA)
- …to change - thrives in a fast-moving, start-up environment Experience with grievances , appeals , or quality assurance within healthcare operations Background in ... Job Description Insight Global is seeking a Remote Operations Support Specialist to join our growing Food Operations team. This role supports the day-to-day… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
