- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Cardinal Health (Boston, MA)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH … more
- Highmark Health (Boston, MA)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Cardinal Health (Boston, MA)
- …appropriate team member (when applicable) + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for ... + Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- Beth Israel Lahey Health (Burlington, MA)
- …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands on coding, documentation review and other coding needs ... the Billing Supervisor with the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. Provides feedback and… more
- Transdev (Readville, MA)
- …internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances. + Understand legal requirements and governmental ... personnel so classified. The physical demands described here are representative of those that must be met by an...legally protected status. The physical demands described here are representative of those that must be met by an… more
- Intermountain Health (Boston, MA)
- …updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7. ... experience leading others or leading project or programs. Certified Revenue Cycle Representative (CRCR) Certification completed within 3 months of hire. Plus one of… more
- Cardinal Health (Boston, MA)
- …each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations ... industry including Commercial and Government plans, Prior Authorizations, and Appeals + Experience with Microsoft Office products including Word, PowerPoint,… more
- Fenway Health (Boston, MA)
- …relationships with supporters who are deeply invested in Fenway's work. Representative Duties: + Develops a comprehensive strategy for individual giving program, ... individual and planned giving programs + Oversee production of all FLC mail appeals and collateral materials + Collaborate with Director of Development on planned… more