- Molina Healthcare (St. Petersburg, FL)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
- Molina Healthcare (St. Petersburg, FL)
- …requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with federal and state ... trends and prepares reports that identify root causes for Appeals, Grievances , and Provider Disputes. Recommends and implements process improvements to achieve… more
- Molina Healthcare (Orlando, FL)
- …that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes. + ... Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina… more
- Humana (Tallahassee, FL)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
- Molina Healthcare (Jacksonville, FL)
- …Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the ... standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for… more
- Humana (Tallahassee, FL)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Elevance Health (FL)
- …law._ The **Manager II Grievance/Appeals** responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to ... grievances and appeals, manages inventory and production levels, and...decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of… more
- Molina Healthcare (Tampa, FL)
- …must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You surface systemic issues, ... Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic defects. 3. Capabilities… more
- Omni Hotels (Fort Lauderdale, FL)
- …Collective Bargaining Agreement for their areas. + Handle union issues including grievances , mediations and arbitrations. + Fulfill all the responsibilities of the ... experience conducting investigations, managing the coaching and counseling and handling grievances . + Must have a well-rounded Human Resources background with solid… more
- Molina Healthcare (Orlando, FL)
- …in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the development/maintenance of Member ... advocate organizations, subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of… more
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