- Point32Health (FL)
- …as a customer service or member services representative in health care or insurance + Preferred: 2 years' Appeals and Grievance experience **Skill Requirements** ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and...NCQA (National Committee for Quality Assurance), DOI (Dept of Insurance ), CMS, DOL and any state or federal specific… more
- Evolent (Tallahassee, FL)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- Elevance Health (Miami, FL)
- **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 Grievance &… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Akumin (West Palm Beach, FL)
- …imaging procedures from insurance companies. Provides supporting documentation for all insurance appeals and denials. + Other duties as assigned. **Position ... Requirements:** + High School Diploma or equivalent experience. + CPR Certification. + 1 year in medical/hospital setting + **Interpersonal Skills:** Relationship building skills to work with all functional units of the organization effectively. Experience in… more
- Humana (Tallahassee, FL)
- …caring community and help us put health first** The Grievances & Appeals Representative 4 Investigates and resolves member and practitioner issues. manages client ... if an a grievance, appeal or further request is warranted. The Grievances & Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- Humana (Tallahassee, FL)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... + Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.… more
- Highmark Health (Tallahassee, FL)
- …could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides ... times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of… more
- TEKsystems (Orlando, FL)
- …companies - Resolve claim rejections for eligibility coverage and other issues - Insurance verification for medication; prior authorization appeals ; speak to ... Hiring For Insurance Verification Coordinator ! 100% REMOTE Note: Candidates...can only apply! Position Purpose: Obtain and verify complete insurance information, including the prior authorization process, copay assistance… more
- TEKsystems (Tampa, FL)
- …to contract extension. + Deep understanding of commercial and government insurance programs, billing, reimbursement, prior authorizations, appeals , and specialty ... specialty prescriptions. + Review and process patient applications, including insurance investigations and financial assessments. + Communicate outcome statuses… more