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Job Description :Nurse Appeals- California candidates only Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Inform nurses of a new case received from Grievance and Appeals Specialist; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Job Title: Grievance and Appeals Coordinator I. Grievance & Appeaks experience required. Please highlight temp worker’s ability to handle multiple tasks and balancing the case load.
RemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Provide assistance with inquiries such as eligibility, authorizations status, patient profile changes, appeals and grievance intake, and various other inquiries. Weave and Revenue Well text messaging.
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Develops an understanding of the grievance and appeals process available to dissatisfied beneficiaries and providers. Our Vision: To deliver value-based care that is clinically effective, sustainable, and achieves exceptional outcome.
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Coordinate and oversee the appeals and grievance process. Our Commitment to Diversity, Equity and Inclusion. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment.
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Participates in ongoing communication to participant/decision maker about Participant Rights, Grievance and Appeals Process, and Care Planning. Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA), Certified Fraud Examiner (CFE), Certified Public Accountant (CPA) and/or an advanced degree is a plus.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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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.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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As an important member of our Medicare Advantage team, you will drive the development, implementation, and execution of organizational and operational strategies for claims, provider contracts, and appeals and grievance systems configuration.
$67,400 - $133,400 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Lead Appeals and Grievance Committee. Position Purpose Analyze and resolve verbal and written claims and authorization grievance/appeals from providers and members.
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As a key member of our Medicare Advantage Claims, Configuration and Appeals, and Grievance Operations team, you will lead and manage a variety of key operational programs, initiatives, and strategic projects.
$64,800 - $137,600 a yearFull-timeExpandUpdated 2 days ago - UpvoteDownvoteShare Job
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Provides documentations as requested by other departments such as Compliance and Member Appeals and Grievance. 5+ years' experience processing Medicare Advantage provider disputes and appeals from all types of providers (hospitals, physicians, ancillary.
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Provides referrals to Social Services, Behavioral Health, Appeals and Grievance, and Quality Departments as necessary. Your WorkIn this role, you will: Perform care management/care coordination for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medi-Cal and CCS/EIES/DDS/ECM Eligibility guidelines.
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Line Staffing is now hiring a Grievance and Appeals Coordinator in Woodland Hills, CA. The Grievance and Appeals Coordinator would be working for a Fortune 500 company and has career growth potential.
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Utilizes leadership skills and serves as a subject matter expert for appeals/grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting the resolution of outstanding issues.
ExpandUpdated 12 days ago
grievance appeals and jobs in Montebello, CA
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