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Oversee all MCO functional areas, including quality management, utilization management, network development and management, provider relations, member outreach and education, member services, contract compliance, and reporting
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Collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, process and clinical outcomes.
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Position Purpose - Field Based Cortland County, NY.The Health Benefit Representative (HBR) sells Fidelis Care products and services by first identifying membership growth opportunities in an assigned territory and then meeting or exceeding production goals by enrolling individuals in the appropriate Fidelis Care product.
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Assist member with filing and resolving complaints and appeals. Bachelor’s degree in Human Services related field defined as Child, Family and Community Services, Early Child Development, Guidance and Counseling, Home Economics- Child and Family Services, Human Development Counseling, Human Service Administration, Human Services, Master of Divinity, Pastoral Care, Pastoral Counseling, Psychiatric Nursing, Psychiatry, Psychology, Public Administration, Rehabilitation Counseling, Social Science, Social Services/Social Work or Sociology.
$21.93 - $37.3 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Provider Services Grievance and Appeals. The Grievance and Appeals (G&A) Customer Service representative will oversee the Gainwell Grievance and Appeals team for our Ohio Department of Medicaid client.
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The denials and appeals specialist demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to hospital services.
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Grievance and Appeals Specialist. Insurance Company, Workers Compensation, Disability, HMO or MLTC. Knowledge of appeals and grievances, claims processing or utilization management/case management in a managed care organization required.
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Provides guidance on risks that may impact the appeals and grievance operations. Manages appeals and grievance process in accordance with the organization's policies and procedures. Identifies potential conflicts when reviewing and resolving appeals and grievances and notifies Appeals and Grievances.
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Superior Health Plan STAR Plus is expanding across Texas in over 100 counties throughout Austin, Corpus Christi, Dallas, Lubbock, and McAllen LPC, LCSW, LMFT, or RN a pplicants must reside in the state of Texas Monday - Friday: 8 am - 5 pm (CST) Mutiple Locations - Apply to JOB ID: 1490933, 1490936, 1491289, 1491293.
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The Appeals Division handles all appellate matters for the City and appears in the Illinois Appellate Court, Illinois Supreme Court, United States Court of Appeals for the Seventh Circuit, U.S. Supreme Court, and occasionally other courts.
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The Bronx District Attorney is seeking an experienced attorney (3+ years) to handle post-conviction litigation, including direct appeals, motion responses, and federal writs of habeas corpus. Brief and argue a substantial caseload of appeals before the state and federal courts.
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Job Summary: The CHS Appeals Specialist works as an integral part of the Revenue Cycle team. Job Title: CHS Appeals Specialist. Knowledge of insurance reimbursement, billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials and appeals recovery.
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Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
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Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
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Responsible for formulating/implementing and executing all processes, requests, workflow, or policies as requested by management in a courteous and efficient manner, including offering a proactive approach to suggestions and recommendations and working or cooperating with Appeals and Grievance Manager or managed effectively.
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Title: appeals Company: Centene Corporation
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