- CenterWell (Denver, CO)
- …the Denials Management data analytics, denial and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face, ... and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of ... of variable factors and determining the best course of action. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- CareFirst (Baltimore, MD)
- …that week. **ESSENTIAL FUNCTIONS:** + Directs all functions related to appeals , grievances , and/or reconsiderations and more for government programs ... health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances . **Preferred Qualifications:** + Significant experience with… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for...assigning all incoming appeals and grievances… more
- Molina Healthcare (Green Bay, WI)
- …Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances . * Coordinates with Corporate and Business Development teams to ... reimbursement tolerance parameters (across multiple specialties/geographies). Obtains input from Corporate , Legal and other stakeholders regarding new reimbursement models… more
- Cedars-Sinai (Beverly Hills, CA)
- …processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins ... management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred +… more