• Medical Director - Medicare Appeals

    CVS Health (CT)
    …based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff *… more
    CVS Health (01/16/26)
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  • Medicare Non Contracted Provider…

    Corewell Health (Grand Rapids, MI)
    …Health - 1231 E Beltline Ave NE - Grand Rapids Department Name Grievance And Appeals Medicare - PH Managed Benefits Employment Type Full time Shift Day (United ... This position will support our non-contracted provider post claim appeals submitted to the health plan. Job Summary Responsible for the analysis, research and… more
    Corewell Health (01/13/26)
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  • Senior Medical Director Appeals , National…

    Centene Corporation (Jefferson City, MO)
    …improvement activities. + Develop and have oversight of training and expertise for Medicare appeals reviews, ALJ hearings. Have oversight of STARS metrics ... NCD's, LCD's, final rules, STARS metrics) and previous experience leading Medicare Appeals , IRE and ALJ hearings, STARS metrics + Previous experience with… more
    Centene Corporation (01/06/26)
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  • Senior Medicaid & Medicare Reimbursement…

    OhioHealth (Columbus, OH)
    …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
    OhioHealth (12/25/25)
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  • Senior Coordinator Complaint Appeals…

    CVS Health (OR)
    …of experience in research and analysis of claim processing. - 1-2 years Medicare part C Appeals experience. **Education:** - High School Diploma **Anticipated ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
    CVS Health (01/16/26)
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  • Senior Coordinator, Complaint & Appeals

    CVS Health (PA)
    …documenting workflows and reengineering efforts **Preferred Qualifications** + 1-2 years Medicare Part C Appeals experience **Education** + High School ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
    CVS Health (01/16/26)
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  • Director, Home Health Grievances & Appeals

    CenterWell (Denver, CO)
    …and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...direction and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS… more
    CenterWell (01/08/26)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (ID)
    …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive… more
    Molina Healthcare (01/15/26)
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  • Patient Account Representative - Medicare…

    Guidehouse (El Segundo, CA)
    …and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service ... + Billing + UB-04 & CMS 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and… more
    Guidehouse (12/12/25)
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  • Prior Authorization Specialist

    US Tech Solutions (May, OK)
    …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
    US Tech Solutions (01/16/26)
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