- UpvoteDownvoteShare Job
- Suggest Revision
Processes claim referrals, new claim handoffs, nurse reviews, provider complaints, and provider grievance and appeals. Work Hours - Could be scheduled between the hours of 7am to 7pm local timeRequired QualificationsFamiliarity with Microsoft Office productsExcellent computer skills using multiple screens and systems to achieve resultsExperience in highly transactional call center environmentExcellent customer service and critical thinkingThis is a fully-remote position.
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 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Applies expert knowledge of the technical aspects of the work directed (employee relations principles and practices, appeals and grievance processes, OWCP, position management, staffing, human resources concepts, and best practices) using knowledge of case laws (MSPB) and precedents, government regulations, executive orders and agency rules.
ExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Provides referrals to Social Services, Behavioral Health, Appeals and Grievance, and Quality Departments as necessary. Your WorkIn this role, you will: Perform care management/care coordination for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medi-Cal and CCS/EIES/DDS/ECM Eligibility guidelines.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Experience in aged claims management and grievance and appeals processing is highly desirable. Job Description: Appeals Coordinator (Hybrid Position)Our client, a leading company specializing in non-invasive skin cancer treatment, is seeking an experienced and detail-oriented Appeals Coordinator to join their team.
Up to $22 an hour (competitive)Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
How you will make an impact:Monitors, trends, and analyzes grievance and appeals data for submission to appropriate parties. 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 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Grievance and Appeals experience or knowledge. This position is dedicated to the Pathways program and solely responsible for guaranteeing Humana has an effective transportation strategy and oversees the NEMT subcontractor.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Appeal and Grievance Specialist position is responsible for day-to-day review, coordination and management of technical denials requiring background and understanding from a provider operational and payer logistical perspective.
$25.72Full-timeRemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Paralegals assist with the University’s responses to internal and external information requests, such as Public Information Act (PIA) requests; subpoenas or court/legal/administrative orders; Employee Grievance Hearings; Public Safety Denial of Access Appeals; and similar matters handled by OGC. As the need arises, Paralegals may be assigned primary responsibility for such matters.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Oengaging and retaining talented faculty to fulfill the needs of the Department and those of the SOM.omonitoring and responding to engagement surveys and exit reports; andocounseling, grievance, and appeals processes.
Full-timeExpandApply NowActive JobUpdated 3 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 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Be proactive in educating members, providers and others about CHRISTUS Health plans appeal/grievance process, plan terminations, contract terminations and benefit summary. Responsible for analyzing, researching, and managing appeal/grievance inventories from members and providers.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
DutiesConducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department.
Full-timeExpandApply NowActive JobUpdated 3 days ago
grievance appeals and jobs
FEATURED BLOG POSTS
Resume Job Description Samples - 8 Tips to Follow
When looking for a job, your resume becomes a crucial element. From making a great first impression to showcasing all your achievements and potential, your resume has to portray your professional story in minutes.
Internship Cover Letter Tips with Examples
Until now, college has been about learning, absorbing, and experiencing. It’s not until you become eligible for an internship that things start getting real—real-world experiences using real-life scenarios. Applying for internships takes time, and there’s no college course on “how to apply for jobs.” (We’d sign up immediately if there was, though!) But here's a spoiler alert: most internships require a cover letter. And while this may seem like a burden, it’s actually a blessing.
5 Practical Ways to Remove Bias from your Hiring Process
Many employers think their hiring process is perfect. However, research shows that the hiring processes are generally impartial and unfair, especially if you are part of certain demographics. Women, people of color, people with disabilities, or even people in lower socioeconomic status are more likely to be subject to implicit bias. As diversity and employer branding become major aspects of business, it is important that employers take the lead to identify and remove bias from the hiring process. So, here are 5 practical ways to get you started.
Tips to Get Your First Job Confidently
Whether you’re a recent graduate or you still have a few exams left, you may be itching to put your polished leather shoes on and join the workforce. After all, your first job is an entryway into the professional life you’d lead for the decades to come.
Tips for a Good Character Reference Letter with Examples
Hiring managers love a resume laden with relevant skills and qualifications. Hard skills specific to the role, like SEO strategy or Java programming languages, are easy to qualify using achievements or facts and figures. But how exactly can they verify personality traits, work ethic, relationship management skills, or curious nature during an interview when they barely know you?
How to Dress on the First Day of Work (Men & Women)
You did it! Out of hundreds of applicants and dozens of people interviewed, you’re the one who got a new job. Congrats! Now comes the question of how to dress on the first day of work.
Why College Students Should Work While in College?
College is a special part of our lives. It’s a time when we prepare for our dream job while creating some of the most memorable moments in life. That said, college life can also be stressful. Not only do we have to spend long hours studying, writing and researching, but we also have to deal with increased tuition fees and living expenses.