- Molina Healthcare (Omaha, NE)
- …8am-5pm PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist ...provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health… more
- Molina Healthcare (Caldwell, ID)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises ... of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... Alliance (CCA) as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this… more
- Molina Healthcare (GA)
- …and Marketplace request authorization. Strongly prefer candidates with a background in appeals and grievances . Excellent computer multi-tasking skills and good ... office with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims… 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
- TEKsystems (Reston, VA)
- …who can come in and hit the ground running Motivated MUST HAVE A&G experience, appeals & grievances - government ( medicare , medicaid, dsnip) side is the ... Description PURPOSE: The Appeals Specialist II will be responsible...assist medical professional staff in performing the review of appeals grievances and reconsiderations. Prioritize research analyze… more
- State of Colorado (Denver, CO)
- …Momentum referrals, obtaining identification, securing a payee, applying for Medicaid/ Medicare , and submitting referrals to potential discharge locations. + Works ... closely with the benefits specialist and reintegration specialist , assists in the completion and monitoring of such documents and referrals, and may collaborate… more
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