- UpvoteDownvoteShare Job
- Suggest Revision
The Accounts Payable Provider - Reimbursement Specialist is responsible for investigating and processing appeals and grievances received by veterans or providers. Obtain relevant medical records to submit appeals or grievance for additional review, as needed.
Full-timeRemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Schedule: Monday - Friday 8:00 am to 4:30 pm PST Saturdays and Holidays requiredHow you will make an impact: Responsible for serving as a team lead and for investigating and processing the most complex grievances and appeals requests from members and providers and provide leadership and work direction to other appeals staff.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement Coordinators with processing pharmacy benefit appeals and grievances.
$45,850 - $55,500 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Manager I - Grievance & Appeals is responsible for the management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.
Starting at $14.76 - $31.97 an hour depends on education, experienceFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
$25 - $31 an hourFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards. Assists in creation of reports, attends, and presents at Plan committee meetings (Grievance, SIC, etc.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Job Summary The Manager, Health Plan Business Operations for Grievances and Appeals is responsible for managing health plan operations and regulatory compliance with emphasis on grievances and appeals, utilization management and claims processing.
$86,756 - $130,134Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Experience in aged claims management and grievance and appeals processing is highly desirable. Knowledge of legal and federally mandated rules regarding claims processing and appeals.
Up to $22 an hour (competitive)Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Job Description :Nurse Appeals- California candidates only Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Works grievance and appeals. Strong written and verbal communication skills, and health claims processing background. Quality Assurance Specialist needs claims , appeals , call center experience.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Provides guidance on risks that may impact the appeals and grievance operations. Manages appeals and grievance process in accordance with the organization's policies and procedures.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Grievance/Appeals Representative I is responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.
Full-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Engagement Description –The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies.
ExpandApply NowActive JobUpdated 4 days ago
grievance appeals and processing jobs
FEATURED BLOG POSTS
How to Avoid a Bad Hire
"A new employee who doesn't meet the minimum performance, quality, and culture fit standards you set when you began sourcing and recruiting. Additionally, bad hires will immediately show signs of self-interest instead of an interest in their role and the company."
How to Ask for a Letter of Recommendation
When the job board you subscribe to finally posts your dream job, you may feel like the stars have aligned. But part of securing a position that matches your career plan is ensuring you address all the application basics. You know, the resume, the cover letter, the portfolio. It seems like you've got this in the bag — until you realize they want a letter of recommendation, too!
16 Tech Jobs You can Get Without a College Degree
You might think that if you don’t have a computer science, information technology, or related degree, then there’s absolutely no way you can break into the technology field and score a high-paying tech job. But this is a misconception. There are actually tons of tech jobs out there that don’t require a college degree. Instead, employers are more interested in the skills that you can offer. So, read on to learn more about how to land tech jobs without a degree.
What Are SMART Goals?
When it comes to achieving our goals, there’s a lot of noise to work through. A study by the University of Scranton has found that only 8% of people who set New Year’s resolutions actually achieve them. Our busy lives might be one reason for this. Another, even more important reason, is our approach to goal setting. Being too vague, too ambitious or simply unclear on the timeframe can set us up for failure.
The Best Remote Jobs: Where & How to Find Them
The Covid-19 pandemic hasn’t been easy on any of us, but if there’s one silver lining, it’s the fact that remote work has grown in popularity because of it. Companies that previously weren’t open to their employees working remotely were suddenly forced into allowing it. Since then, they've realized that much of their workforce is happier and more productive. Naturally, this has led to more remote job openings, which is great if you’re interested in this type of position. Read on to learn more about the best remote jobs and where to find them.
In-House vs Outsourcing Recruiting: Which is Better?
When looking at in-house vs outsourcing recruiting, it is important to nail down the benefits for each and whether those benefits outweigh the risks that follow.
How to Write a Short Bio
First impressions can be tricky. When meeting someone in person, it’s likely you have an elevator speech. These short, practiced introductions can help you share more about who you are, what you do for work and other facts about you. While this works well in a live, in-person context, there are many cases where professionals “meet” someone via written form - like social media, a resume, or published work. In these cases, your bio works as your first impression. So, here’s a step-by-step guide on how to write a short bio.