- CVS Health (Sacramento, CA)
- …day. **Position Summary** Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require ... issues and report and recommend solutions. Research incoming Medicare Fast Track appeals to identify if appropriate for unit based upon published business… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Robert Half Accountemps (Los Angeles, CA)
- …IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist. The Grievance & Appeals Specialist, will be in responsible for ... claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your extensive… more
- Lincoln Financial (Sacramento, CA)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter expert to ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Humana (Sacramento, CA)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and… more
- City and County of San Francisco (San Francisco, CA)
- …denial of services, permits, enforcement actions administrate regulations and appeals processes; cash handling principles and basic arithmetic; technical ... denial of services, permits, enforcement actions administrate regulations and appeals processes; cash handling principles and basic arithmetic; technical… more
- City and County of San Francisco (San Francisco, CA)
- …examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service Commission. ... Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis'...position description, the minimum qualifications and/or the certification rule. Appeals must include a written statement of the item(s)… more
- CenterWell (Sacramento, CA)
- …to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and ... collaborates with branch and billing staff to determine appropriate response, manages appeals process. + Monitors and responds to all requests related to revenue… more
- City and County of San Francisco (San Francisco, CA)
- …examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service Commission. ... Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis'...position description, the minimum qualifications and/or the certification rule. Appeals must include a written statement of the item(s)… more