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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.
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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 12 days ago - UpvoteDownvoteShare Job
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Other duties include, but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic testing, etc.
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The Grievance & Appeals Compliance Specialist, in coordination with Corporate Regulatory staff, ensures the Grievance & Appeals (G & A) team is in compliance with contract requirements and ensures that review, submission and required reporting deadlines are met.
Full-timeRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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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 6 days ago - UpvoteDownvoteShare Job
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Managing case work end to end covering settlements, PIPs, absence management and all aspects of grievance and disciplinaries (investigations, hearings, mediations, appeals, terminations) in line with legal requirements and company policy Support business change activities restructuring, transfer (TUPE), redundancies and settlement/termination agreements.
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Assist Members with but not limited to (benefits, PCP lookup, appointment setting, scheduling transportation, and documenting Grievance and/or appeals). The Member Care Professional may also facilitate the process for Health-Education related activities and other Health Plan functions and events.
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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 6 days ago - UpvoteDownvoteShare Job
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Meets performance measurement goals for Grievance and Appeals Resolution Services. Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
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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.
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Update inaccurate information from the Electronic File Schedule face to face meeting with member and other team members to provide education about Care Teams, and services Provide education and support, to individuals and other supports, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
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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.
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Review Level of Care for iCare members including follow-up consultation with Grievance and Appeals or Enrollment/Eligibility/Fiscal staff. The Screener is responsible for screening members within the iCare Family Care Partnership service areas, as well as participate in all iCare and WI State LTCFS required compliance and quality assurance activities.
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Description Clinical Operations Associate Medical Director Carelon Medical Benefit Management Interventional Pain Benefit Review Location : This position will work a hybrid model (remote and office.
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grievance and appeals jobs
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