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May coordinate the Grievance and Appeals Committee. 2+ years grievance or appeals, claims or related managed care experience. Prepare response letters for member and provider complaints, grievances and appeals.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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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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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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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.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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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 6 days ago - UpvoteDownvoteShare Job
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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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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
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Responsible for reviewing and sorting all incoming correspondence for all departments, including but not limited to Claims, Grievance/Appeals, COB/TPL, and Member Reimbursement. Able to prioritize work tasks with the day to day business from other departments, including but not limited to Provider Relations, Compliance, Claims, COB/TPL and Provider Appeals.
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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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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.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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In some cases may be combined with Grievance Coordinator functions. Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests.
Full-timeRemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvote
RN / Care Coordinator / California / Permanent / Behavioral Health Registered Nurse Case Manager Job
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Makes referrals to Quality Management, Catastrophic Case Management and Appeals and Grievance Department. Coordinates Care for Lower Level of Care coordination such as Skilled Nursing Facility, Residential Treatment Center, Home Health, Home Infusion, Rehab Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Job Title: Grievance and Appeals Coordinator I. Grievance & Appeaks experience required. Job Title: Grievance and Appeals Coordinator I. Grievance & Appeaks experience required.
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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.
Full-timeRemoteExpandApply NowActive JobUpdated 10 days ago
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