- Molina Healthcare (Layton, UT)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to...of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals … more
- 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...will be responsible for the research and resolution of Medicaid provider appeals that will involve research… 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 ... Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual,...experience in an administrative clinical setting, including 1-2 years Medicaid managed care appeals process & Health/Human… 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
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and… 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
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