- AmeriHealth Caritas (Philadelphia, PA)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor , Appeals and Grievances, this position is responsible for ... the administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals ,...provider appeals , the analysis of claims and appeals , and the review of medical management authorizations.; +… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- State of Massachusetts (Boston, MA)
- …Records ( Supervisor ), the Division processes and issues determinations on appeals from petitioners denied access to government records; responds to inquires ... case-law, statutes, regulations, Attorney General Opinions, Executive Orders and prior Supervisor Determinations; . Review appeals from public records requesters… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...Federal and State Regulations. Complete individual summary scorecards for Supervisor feedback. + Track monthly scores on spreadsheet and… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- State of Michigan (Lansing, MI)
- Departmental Technician Hearings & Appeals 7-E9 Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/5050132) Apply Departmental Technician ... Hearings & Appeals 7-E9 Salary $22.55 - $30.98 Hourly Location Lansing,...Departmental Technician E9 One year of experience as a supervisor of administrative support activities equivalent to the 9-level… more
- HonorHealth (AZ)
- …medical records documentation and billing statements on patient accounts; submits appeals to payers on patient account denials when appropriate; reviews medical ... appeal is clearly presented. Prioritizes and organizes own work to meet appeals and grievance deadlines. Responsible for the denials process, including subsequent… more
- TEKsystems (Richmond, VA)
- …Process specialized cases with a high degree of difficulty. - Work and research appeals at supervisor discretion. Serve as SME on eligibility policy and ... processes for team and understand impact on other teams. - Work closely with management and work groups to create and maintain work plan documents. - Track the status and due dates of projects. - Collaborate with project managers on various initiatives and… more
- City and County of San Francisco (San Francisco, CA)
- …. Under general direction, the 9230 Airport Custodial Services Supervisor is responsible for all custodial services, furniture and equipment ... to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or...Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis'… more