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Research and resolve grievance and appeals for the commercial line of business, utilizing a higher level of adjudicator expertise, clinical interpretation and decision making.
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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 6 days ago - UpvoteDownvoteShare Job
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May be called upon to testify on behalf of the Company during the Union grievance process, Accident Review Committee meetings, Safety appeals meetings, and other legal or administrative proceedings.
$23.91 an hourFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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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 8 days ago - UpvoteDownvoteShare Job
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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 5 days ago - UpvoteDownvoteShare Job
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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
RemoteExpandApply NowActive JobUpdated 7 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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Senior Grievance and Appeals Specialist. Knowledge of Medicare/Medicaid Grievance and appeals process. Handle inbound calls related to grievances, bills, appeals and access related issues.
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Experience in Medicare Advantage Claims, Appeals & Grievances, program/project managementExperience in leading, facilitating, and implementing new programs and/or projects. The Program Manager leads and manages key operational programs, initiatives and strategic projects that span across the functional teams of Claims, Configuration and Appeals and Grievances.
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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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This position expected to provide excellent customer service to all incoming/outgoing callers and answer and document inquiries related to dental benefits , eligibility, provider information, claims, pre-estimates/pre-authorizations, grievance and appeals, fulfillment requests and other miscellaneous inquiries.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
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Support the local HRBP in the employee appeals and grievance process. Facilitates initiatives to foster a positive employee relations environment that aligns with the mission and values of Adventist Health System.
$31.83 - $47.74Full-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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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 8 days ago - UpvoteDownvoteShare Job
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May also engage in grievance and appeals reviews. Become a part of our caring community and help us put health first. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation.
ExpandApply NowActive JobUpdated 12 days ago
grievance and appeals jobs
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