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The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. Ability to function and excel in a remote environment handling time critical appeals and grievance cases.
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Handle a large volume of incoming grievance and appeals from receipt through resolution, ensuring that all appeals are resolved within contractual timeframes. Experience leading appeals and grievances for Commercial, Medicaid and Medicare products and plans preferred.
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Represent clients in communications and negotiations with MassHealth and Health Connector officials, health care providers, managed care entities, and in appeals before the Office of Medicaid Board of Hearings.
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The Commonwealth of Massachusetts received a waiver from the Centers for Medicaid and Medicare to improve the ways in which MassHealth provides care to its members. Haitian Creole-Speaking Nutrition Services Coordinator.
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Accountable for understanding federal and state health care law requirements applicable to CCA, including Medicare and Medicaid rules, HIPAA privacy and security, healthcare reform, legal and regulatory topics relating to CCA's status as a government contractor and integrated health care services delivery organization, Accountable Care Organization requirements, and insurance and managed care regulatory requirements.
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The attorneys will be responsible for conducting jury and non-jury trials, as well as oral arguments before the Commonwealth's state trial courts, the Massachusetts Appeals Court, the Supreme Judicial Court, Federal District Courts, and the First Circuit Court of Appeals, with the majority of cases filed in Boston or in contiguous counties.
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Take the lead in developing patient complaint/grievance dashboard, analyze result and reports with meaningful trends and insight to leadership and C3 (for MassHealth enrolled patients) Excellent customer service skills for patient grievance resolution.
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As necessary, assists the Housing Appeals Committee Docket Clerk with various miscellaneous administrative tasks, such as scheduling, maintenance of dockets and files, preparation of record on appeal for the Office of the Attorney General.
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P rovides legal services and support to the Housing Appeals Committee (HAC), in the conduct of hearings and researching and preparing draft decisions and legal memoranda for and in cooperation with the Chair of the HAC. Provides legal services and support to EOHLC staff, with a focus on real estate development, and affordable housing finance programs administered by EOHLC.
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Clinician will be either credentialed with United Healthcare, Cigna, BCBS, Alliance Medicaid, Partners Medicaid, Amerihealth, WellCare, Carolina Complete Health, and/or Healthy Blue or willing to pursue in order to provide care to our client population.
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Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana Farber Cancer Institute and various health plans.
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Refer elders to other programs when appropriate, which may include Medicaid Waiver, Respite, Managed Care, Supportive Housing, or other relevant resources. Work in collaboration with other CBES Departments to ensure timeliness and quality of care delivery as set by the EOEA regulation, Central of Medicare and Medicaid (CMS) Quality Measures, and Agency policy.
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The TNC Counsel I (Hearing Officer) will be primarily responsible for managing and developing a caseload of appeals from rideshare drivers denied by the Division to drive for a rideshare company.
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The incumbent will assist the Billing and Claims Manager with effectively managing the BUGSDM Accounts Receivable, in particular items billed to MassHealth and other state Medicaid programs. This position is responsible to review and investigate denials from the Medicaid/MassHealth administrator(s), i.e. Dentaquest, resubmit claims, processing adjustments to accounts within system, including write-offs and billing to the patients, as appropriate.
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grievance appeals medicaid jobs in Somerville, MA
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