- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals &… more
- Sharp HealthCare (San Diego, CA)
- …Will Do** Responsible for the investigation, documentation and resolution of member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
- Sharp HealthCare (San Diego, CA)
- …Do** Responsible for the investigation, documentation and resolution of Commercial member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
- Sacramento County (Sacramento, CA)
- Treatment Center Program Coordinator Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1180508) Apply Treatment Center Program Coordinator ... Service Commission, 700 H Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days after notice of the… more
- Elevance Health (Fresno, CA)
- …to client needs, and direct, hands-on engagement. The **LTSS Service Coordinator ** is responsible for conducting service coordination functions for a defined ... + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a… more
- Cardinal Health (Fresno, CA)
- …escalate issues. + Analyze denials and underpayments to determine appropriate action ( appeals , corrections, resubmissions). + Track and follow up on all submitted ... appeals until resolution. + Analyze explanation of benefits (EOBs) and remittance advice to determine the reason for denial or reduced payment. + Document all… more
- Cardinal Health (Sacramento, CA)
- …* Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... fully exhausted * Track any payer/plan issues and report any changes, updates, or trends to management * Search insurance options and explain various programs to the patient while helping them to select the best coverage option for their situation * Handle all… more
- Cardinal Health (Sacramento, CA)
- …industry including Commercial and Government plans, Prior Authorizations, and Appeals + Experience with Microsoft Office products including Word, PowerPoint, ... Teams, Outlook, and Excel + Excellent observation skills to easily identify trends and problems while providing solutions + Superior written & verbal communication skills + Required to effectively present information in a one-on-one and small group situations… more
- City and County of San Francisco (San Francisco, CA)
- …the following duties: QUALITY CONTROL, INVESTIGATIONS, OVERPAYMENTS, AND/OR APPEALS SPECIALIST Under general supervision, the Quality Control, Investigations, ... Overpayments or Appeals Specialist performs investigations in support of human service...phone assignments. + Works with manager and/or Benefits Center Coordinator to identify issues causing service gaps and reviews… more
- The County of Los Angeles (Los Angeles, CA)
- …update parcel information, and/or enroll property tax assessments. + Prepares assessment appeals cases and testifies as an expert witness at Assessment Appeals ... the assessment process, for Part I contact the Testing Accommodations Coordinator ###@hr.lacounty.gov, for Part II ###@assessor.lacounty.gov. We require a completed… more