- CVS Health (Austin, TX)
- …within budgeted costs. **What you will do** + Acts as a top-level specialist on project management and develops a comprehensive plan that encompasses objectives, ... Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and audit… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …than the sum of its parts. Join our dynamic team as a Benefits Investigation Specialist and be a crucial part of ensuring access to essential medications! We seek a ... compassionate individual to engage with Medical Insurance Payers and Pharmacy Benefit Managers, playing a vital role in identifying and documenting coverage options… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …atwww.voala.org. PAY RATE:$80,116.92 - $84,333.60 Per Year BENEFITS:VOALA offers competitive medical , dental, vision and retirement benefits. JOB SUMMARY AND PURPOSE ... resolution of facts and issues in matters affecting disciplinary actions, grievances, appeals , and complaints, refers complex matters to HR Employee Relations … more
- The Cigna Group (Arlington, VA)
- …others achieve the best outcome? We are looking for a dedicated onsite specialist to provide exemplary customer and client service of our Cigna products, benefits, ... the employees. Including but not limited to complex claims, authorizations, denials, appeals , incentive issues, etc. + You will provide education and guidance around… more
- Molina Healthcare (Los Angeles, CA)
- …unrestricted in state of practice. * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... thought process is important to be successful in this role. Experience with Appeals , Auditing, and Compliance /Quality will be a good fit for this position.… more
- Community Health Systems (Franklin, TN)
- …and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical ... ensuring compliance with policies, regulations, and payer requirements to establish medical necessity. + Communicates with commercial payers to provide concise and… more
- Bristol Myers Squibb (Tampa, FL)
- …for escalation and resolution of Tier 2 queries, plan interpretation and appeals . + Responsible for ensuring internal processes are documented and updated versions ... Workday, ServiceNow, ADP and vendor management. + Certified Employee Benefits Specialist (CEBS) or equivalent Industry designation, preferred. \#LI-Hybrid If you… more
- Molina Healthcare (Long Beach, CA)
- …unrestricted in state of practice. * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... in this role. Productivity is important with quick turnaround times. Experience with Appeals , Auditing, and Compliance /Quality will be a good fit for this position.… more
- Cardinal Health (Sacramento, CA)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement....benefits and programs to support health and well-being. + Medical , dental and vision coverage + Paid time off… more
- State of Colorado (Colorado Springs, CO)
- …and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules . Supplemental Information Please ... the selection process and will be reviewed by a qualified Human Resources Specialist to determine if applicants meet the minimum qualifications for this position.… more