- Randstad US (Woodland Hills, CA)
- …, claim denials, medical terminology and CPT codes. Previous Grievance and Appeals experience preferred . Ability to communicate with providers and members ... grievance and appeals coordinator. + woodland hills , california +...client of Randstad's has openings for experienced Grievance and Appeals Coordinators. Must be experienced with grievance and … more
- Universal Health Services (Richmond, VA)
- …Position Requirements: + High school diploma or equivalent, Associate's degree or higher preferred + 3-5 years appeals experience preferred + Strong ... Region CBO is seeking a dynamic and talented Senior Appeals Specialist. The Senior Appeals Specialist is...appeals and 3-5 years healthcare business office experience preferred Disclaimer The Atlantic Region CBO is not accepting… more
- Universal Health Services (Richmond, VA)
- …Qualifications Position Requirements: + High school diploma or equivalent + 1-3 years appeals experience preferred + Strong Microsoft Office skills (Excel, Word, ... with appeals and 1-3 years healthcare business office experience preferred This opportunity provides the following: + Challenging and rewarding work environment… more
- Elevance Health (Woodland Hills, CA)
- …States required. ** Preferred Capabilities, Skills and Experiences:** + UM experience preferred + Appeals experience preferred + Managed Care experience ... **Nurse Appeals - California candidates only** **Location: This is a... preferred + AS or BS in Nursing preferred + For URAC accredited areas, the following professional… more
- Scripps Health (San Diego, CA)
- …Preferred Qualifications:* * Bachelor's degree preferred . * Notary license preferred . * Appeals experience preferred . **Job:** **Business Office* ... the county, monitoring of the applications, through to the highest level of appeals while adhering to all policies on fraud/abuse and providing excellent customer… more
- Texas Health Resources (Arlington, TX)
- …knowledge and application of Milliman or InterQual criteria required + Case management experience preferred + Denials and Appeals experience preferred + RN ... **Clinical Reviews, Denial and Appeals RN** **Work location:** Remote but must live...Degree in Nursing required + Bachelor's Degree in Nursing preferred + 3 years Inpatient clinical nursing experience in… more
- Centene Corporation (Austin, TX)
- … preferred . Advanced knowledge of NCQA and state Medicaid program requirements preferred . Advanced knowledge of appeals process preferred . Pay Range: ... on workplace flexibility. **Position Purpose:** Manages the denials and/or appeals , disputes, and reconsiderations process including the drafting and review… more
- CareFirst (Baltimore, MD)
- …health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances. ** Preferred Qualifications:** + Applicants with specific ... of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead… more
- Martin's Point Health Care (Portland, ME)
- …Advantage (for Medicare Specialist) or TRICARE (for USFHP Specialist) appeals processes and regulations strongly preferred Skills/Knowledge/Competencies ... Place to Work" since 2015. Position Summary Job Description Position Summary: The Appeals Specialist (Medicare or US Family Health Plan) is responsible for ensuring… more
- CVS Health (Hartford, CT)
- … Qualifications * Medical Management - Medicare Complaints, Grievance & Appeals experience.* Health Plan Experience Highly Preferred EducationPlease replace ... of this Medical Director role are related to Medicare Appeals .* Direct daily work on part C appeals... Appeals .* Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part D… more