- Martin's Point Health Care (Portland, ME)
- …certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... role supports Appeals quality goals through quality monitoring and training . This role partners directly with Appeals leadership to support on-going… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible...is responsible for assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... records into EPIC, maintaining a 95% coding accuracy rate as measured through quality reviews. + Queries physicians when code assignments are not clear and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution… more
- Adecco US, Inc. (Ontario, CA)
- …for you? + Pay: $26.75/hour + Shift: Monday-Friday, 8:00 AM-4:30 PM (same for training ) + Weekly paycheck + Dedicated Onboarding Specialist & Recruiter + Access ... Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This...as point of contact for member grievances and potential quality of care issues + Process and document grievances… more
- Commonwealth Care Alliance (Boston, MA)
- …NCQA and other related quality program activities including: monthly case quality monitoring, coordination of training initiatives, coordination of Peer to ... monthly quality results and identifying opportunities for improvement and training and areas on noncompliance. In addition to NCQA program support, this… more
- Molina Healthcare (Omaha, NE)
- …resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training , leadership and mentoring for ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Long-Term Services & Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases… more
- City and County of San Francisco (San Francisco, CA)
- …perform the following duties: QUALITY CONTROL, INVESTIGATIONS, OVERPAYMENTS, AND/OR APPEALS SPECIALIST Under general supervision, the Quality Control, ... the department's interpretation of regulations, and providing legally binding stipulations. TRAINING AND POLICY DEVELOPMENT SPECIALIST Under general supervision,… more