- Elevance Health (Mason, OH)
- **Title: Grievance / Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law._ The ** Grievance / Appeals Analyst I** is an entry level position in the Enterprise … more
- Molina Healthcare (Cincinnati, OH)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... group of employees responsible for submission, intervention and resolution of appeals , grievances, and/or complaints from Molina members, providers and related… more
- Molina Healthcare (Akron, OH)
- …Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager ... and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals / grievance and/or claims processing within a managed care setting.… more
- Molina Healthcare (Cincinnati, OH)
- …procedures regarding compliance with local, state and federal guidelines. * Establishes member grievance appeals and policies and updates annually or as directed ... for Medicare and Medicaid Services. * Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the… more
- Humana (Columbus, OH)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.… more
- Elevance Health (Mason, OH)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... consistent use of medical policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD or DO and… more
- CVS Health (Columbus, OH)
- …contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with ... credentialing/re-credentialing and contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal… more
- Humana (Columbus, OH)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
- Molina Healthcare (Akron, OH)
- …Management + Experience working with complex, often highly technical teams + Appeals & Grievance , healthcare services, or claims background **Preferred License, ... Certification, Association** Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred To all current Molina employees: If you are interested in applying for this position, please apply through… more
- Molina Healthcare (Akron, OH)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
Recent Searches
- Utility Engineer Maintenance Helper (United States)
- Lead Design Engineer (United States)
- Records Manager Supervisor (United States)
Recent Jobs
-
Clinical Nurse Coordinator Med Surg Tele
- HCA Healthcare (San Antonio, TX)
-
Cleaner
- ASM Global (Austin, TX)
-
Access Center Lead Agent - Call Center- Hicksville, Long Island, New York, HYBRID, Full Time, Days, Offsite
- Mount Sinai Health System (Huntington, NY)
-
Executive Agency Counsel, Non-Managerial (Level A & B- Litigation)
- MTA (Brooklyn, NY)