- Molina Healthcare (South Charleston, OH)
- …**KNOWLEDGE/SKILLS/ABILITIES** + Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the ... requirements. + Maintains call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each… more
- Elevance Health (Mason, OH)
- …will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... Director for final review and decision. + Ensures that appeals and grievances are resolved timely to...or any combination of education and experience, which would provide an equivalent background. + Current active unrestricted RN… more
- Molina Healthcare (Columbus, OH)
- …+ Deep understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, ... management with direct impact on Claims Operations (adjudication, configuration, appeals / grievances , payment integrity, provider data). **Preferred… more
- Insight Global (Mayfield Heights, OH)
- …Authorization/Gold Carding, Eligibility/Benefits Verification, Claim Submission, Adjudication, Payment, Appeals / Grievances ) * Clear and confident communicator, ... standards and procedures, and prioritize them for assigned areas * Provide guidance, recommendations, and mentor other business analysts on approach, guidance,… more
- Elevance Health (Mason, OH)
- …unless an accommodation is granted as required by law. The **Vendor Implementation Manager ** is responsible for Provider Network 3rd party delegated dental, ... **Vendor Implementation Manager ** **Hybrid 1:** This role requires associates to...Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + Experience with… more
- Elevance Health (Chillicothe, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring near Cambridge, Colerain, Chillicothe, Coschocton, Hillsboro, Ironton, Mansfield, Marion, Mount Orab, Mount… more
- Sharecare (Columbus, OH)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... an exciting and innovative remote role newly created to provide meaningful support to members and their families through...payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management… more
- Molina Healthcare (Columbus, OH)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines… more
- Elevance Health (Mason, OH)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... or any combination of education and experience, which would provide an equivalent background. + Current State Pharmacy Tech....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Mason, OH)
- …relevant parties of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, ... or any combination of education and experience, which would provide an equivalent background. + Current State Pharmacy Tech....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more