- CareFirst (Baltimore, MD)
- …The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Government ... or insurance payor environment **Preferred Qualifications** + Previous experience working in an appeals and grievance department in a health care setting. +… more
- Molina Healthcare (St. Petersburg, FL)
- …Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving ... and requirements established by the Centers for Medicare and Medicaid . This position will provide direct support to the...with state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the… more
- Molina Healthcare (Des Moines, IA)
- …Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager ... and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals / grievance and/or claims processing within a managed care setting.… 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, US, ... 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
- Humana (Springfield, IL)
- … Medicaid or DSNP Members. + Knowledge and/or experience in working with grievance and appeals . + Intermediate to advanced knowledge of Microsoft Office Suite ... Experience Lead who is dedicated full-time to member services for the Illinois Medicaid Market. This Lead leverages the voice of the customer, root cause, telling… more
- Humana (Montpelier, VT)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Humana (Salem, OR)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team… more
- Humana (Charleston, WV)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Humana (Bismarck, ND)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/… more
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... provides guidance and oversight to all lines of business including Commercial, Medicaid , Medicare, and Special Need Plans (SNPs). The Director, Quality will work… more
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