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Prepares reports on grievance and appeals as required by regulatory agencies, NCQA standards, and Plan management. Maintains appropriate documentation in IDX Customer Service Module to ensure accurate and thorough documentation of appeals/grievance process.
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The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Registered Nurse (RN) - Care Coordinator Bilingual (Community) Registered Nurse - Care Coordinator is part of an innovative multi-disciplinary care coordination team addressing OHP and CareOregon Advantage members' needs.
$87,135 - $105,435 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Minimum of four years of administrative support experience in a health care organization required Knowledge of DOH and CMS Grievance and Appeals regulatory requirements and procedures for ensuring compliance preferred Proficient PC skills, including MS Excel, Word, and Access required Knowledge of Facets system preferred.
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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.
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Responsible for initiating the initial research on the appeal/grievance from the numerous systems to ensure all data is captured for entry into the appeals and grievances system. The Resolution Coordinator is also the forefront of any incoming correspondence to the Appeals unit.
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Assist Supervisor with special projects and CMS quarterly reports as it relates to Grievance and Appeals. Receives and responds to member and/or provider written and oral complaints and requests in accordance with CommunityCare's grievance and appeals procedures.
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Ability to function and excel in a remote environment handling time critical appeals and grievance cases. Handle a large volume of incoming grievance and appeals from receipt through resolution, ensuring that all appeals are resolved within contractual timeframes.
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The Junior Grievance Coordinator is a supportive member of the Grievance and Appeals team, ensuring AlohaCare members and providers of compliant, ethical, and timely resolution of their grievance or appeal.
$16.5 - $18 an hourExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Coordinate and oversee the appeals and grievance process. The Quality Improvement Coordinator is devoted to upholding this level of care by maintaining all compliance-focused initiatives that make up our Quality Improvement (QI) program.
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Supervises and manages the Academic grievance and appeals process. Title IX Coordinator: Dr. Devonye C. Brown, Fine Arts Building, Suite C-01 (318) 670-9225: Section 504 Coordinator: Dr. Anjelica Hart, NCR Building, Room 125, (318) 670 -9367.
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Seek to resolve differences in accordance with the scriptural patterns summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure. Seek to resolve differences in accordance with the scriptural patterns summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure.
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Benefits of this role:·Weekly pay·Work fully remote / no weekends·Helpful and supportive leadership and executives·Opportunity to work for one of the top Healthcare organizations in Ohio. A Day in the Role:·Gather analyze and report verbal and written member and provider complaints grievances and appeals.
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The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the care management/continuity of care process including intake, logging, tracking and status follow-up.
$47,840 - $68,474 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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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-timeExpandUpdated Yesterday
grievance appeals coordinator jobs
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