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Oversees the Member Appeals and Grievance process; completes analytics to identify trends; and executes strategies to improve member satisfaction. Serves alongside the VP, Health Plan Operations as liaison for MHI Operations, including: Claims, Configuration Information Management, Provider Data Management, Credentialing, Enrollment, and Contact Center Operations.
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Regulatory Associate Responsibilities: Conduct legal research and analysis related to provider reimbursement issues, Medicare and Medicaid appeals, audits, and internal investigations.
$185,000 - $285,000RemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Departments reporting to this position include: Appeals and Grievance, Claims, Enrollment and Reconciliation, Premium Billing, Member Service and Experience, and Member Innovation.
$300,000 - $350,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Also responsible for: preparation of internal reports and maintain documentation of the approved budgets, review and recommendation of appeals of the approved budget; assist with submissions of contract renewal, OCAF, and budget submission; preparation of special reports requested by RHF management; keeping abreast of current HUD and agencies regulations and policies.
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1+ year s medical provider experience working with UB04, appeals & denials. Appeals & Denials. This position will be on a hybrid schedule working two days in the office and three days from home.
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They are responsible for maintaining the clinical integrity of the program, including timely peer reviews, appeals and consultations with providers and other community-based clinicians, including general practitioners and will work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff.
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Makes medical necessity determinations for grievance and appeals appropriate for their specialty. The Sleep Clinical Operations Associate Medical Directo r is a Sleep Specialist participating in pre-authorization and quality improvement solutions for sleep studies and high-tech general medicine diagnostic imaging.
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Knowledge of appeals and denials. Surgery Partners owns and operates more than 180 locations in 32 states, including surgical facilities and ancillary services comprised of multi-specialty physician practices and anesthesia services.
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Conduct peer-to-peer with Health Plan Medical Directors to discuss grievances, appeals, and/or overturns. MedPOINT, a large MSO in the San Fernando Valley, offers competitive salaries and benefits in a collaborative working environment.
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Hiring For Grievance and Appeals Coordinator. Summary: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
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Appeals and denials management. The Medical Collections Specialist will be tasked with following up with insurance rendered regarding denials and rejections. The Medical Collections Specialist must be well versed with Medi-Cal, HMO, PPO and Government insurance.
$21.85 - $26.3 an hourExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Assures an understanding of the Area Directors' view on various problems and work situations not requiring a comprehensive technical knowledge of Appeals issues. Typing Proficiency: Candidates must meet the typing proficiency and office automation skills, as well as the experience and/or education required for this position.
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Conduct legal research and analysis related to provider reimbursement issues, Medicare and Medicaid appeals, audits, and internal investigations. The Regulatory Associate will primarily focus on provider reimbursement issues, Medicare and Medicaid appeals, and audits and internal investigations, supporting the firm's robust and sophisticated regulatory and reimbursement practices.
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Senior-level knowledge of workers' compensation law, Appeals Board and appellate court rules of procedure, and other related substantive areas of law. The attorneys will conduct settlement negotiations, conduct discovery including, interview witnesses, and participate in all hearings before the Workers Compensation Appeals Board.
$140,000 - $160,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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10+ years of experience in civil litigation, including all aspects of civil trial and appellate litigation in state/federal court, including case development and filing, discovery, motions practice, evidentiary proceedings, trials, appeals, mediation, settlements, and budgets, with a strong background in civil rights and public interest law.
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appeals and jobs in Lakewood, CA
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