- Cognizant (St. Paul, MN)
- Provider Appeals & Grievances Specialist (remote) This is a remote position open to any qualified applicant that lives in the United States. Summary: We ... are seeking a dedicated Provider Appeals & Grievance Specialist ...directly with CMS Billing and Coding-Medical Insurance Knowledge of Member/ Provider Appeals and Grievances , processes,… more
- Molina Healthcare (Akron, OH)
- …(CMS). Essential Job Duties Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... agencies to ensure that internal and/or regulatory timelines are met. Researches claims appeals and grievances using support systems to determine appropriate … more
- Molina Healthcare (Grand Rapids, MI)
- …KNOWLEDGE/SKILLS/ABILITIES Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, ... agencies to ensure that internal and/or regulatory timelines are met. Research claims appeals and grievances using support systems to determine appeal and… more
- Commonwealth Care Alliance (Boston, MA)
- …issues. Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and resolve ... Medicare, and commercial payment methodologies and supports audit, compliance, and provider engagement initiatives. This role also provides support in managing … 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I... team to receive, investigate and resolve member and provider complaints and appeals ; escalates complex issues… 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 ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... role will work identify root causes of issues and provide real time solutions for members that have a...failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately… more
- Molina Healthcare (San Antonio, TX)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… more
- Molina Healthcare (Bowling Green, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
