- Cognizant (Juneau, AK)
- **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 with 1 to...with CMS Billing and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances , processes, resolutions, compliance TAT… more
- Molina Healthcare (Columbus, OH)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… 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 ... Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and Grievances… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- Area Agency On Aging 1-b (Southfield, MI)
- … and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and accreditation ... and in administrative hearing proceedings. Duties Include: + The Appeals and Grievance Specialist is responsible for... Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual,… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... goals through quality monitoring and training. This role partners directly with Appeals leadership to support on-going team development and growth. This role creates… more
- Actalent (Dallas, TX)
- Job Title: Specialist , Appeals & GrievancesJob Summary: Responsible for reviewing and resolving member and provider complaints and communicating resolutions. Key ... Responsibilities: + Conduct comprehensive research and resolve appeals , disputes, grievances , and complaints. + Use internal systems to determine outcomes of… more
- Cognizant (Phoenix, AZ)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- BayCare Health System (Clearwater, FL)
- …provide updates to management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future ... respect, responsibility and clinical excellence. **Summary:** + Manages intricate grievances , collaborating closely with healthcare providers and members to resolve… more