Medicare Appeals Specialist - Remote (PST)
$21.16 - $38.37 per hourMolina Healthcare, Inc.
- Remote job
A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention to detail, organizational skills, and proficiency in Microsoft Office. The role offers an hourly pay range of $21.16 - $38.37, depending on qualifications and location. #J-18808-Ljbffr Molina Healthcare, Inc.
$21.16 - $38.37 per hour
Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office- ...Solutions is seeking a Denials Specialist for a contract-to-hire role in... ...own end-to-end denial and appeal workflows, audit data, and drive timely payments across Medicare, Medicaid, and managed care. The... ...weeks, then transitions to fully remote work. You will collaborate...Remote workContract work
$30.7k - $66.5k
...This position works PST hours and requires flexibility to work weekends based on business... ...established by the Centers for Medicare and Medicaid Services (CMS). Essential... ...comprehensive research and resolution of appeals, disputes, grievances, and/or complaints...Remote workFull timeContract workWork at officeWeekend work$60.78k
...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances Location... ...in compliance with Centers for Medicare and Medicaid Services (CMS), California... ...hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workFull timeLocal areaShift workWeekend work- Elevance Health, Inc. is seeking a Sr. SCA Appeals Representative to investigate and review member appeals related to service and benefit coverage. The role supports Wellpoint Federal and requires navigating complex regulatory guidelines with a focus on timely resolutions...Remote job
$66k - $68k
WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale... ...and communication skills are essential. The role offers remote work options across approved states, with a base salary in the...Remote job- ...with a New York health plan. You will own clinical grievances and appeals from intake to final decision letters, applying medical... ...judgments based on InterQual/MCG criteria. The position is 100% remote in the United States, with business hours and occasional evenings...Remote jobContract workAfternoon shift
- ...Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings... ...strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or...Remote work
- ...Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve... ..., and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone. Required: high...Remote work
- ...Partner Company is a healthcare organization focused on pediatric care and research, seeking a specialist to manage denial and appeal follow-up within a fully remote team. The role requires working with revenue integrity teams and leveraging tracking systems to monitor...Remote work
$56.27k - $69.9k
Pay Plan Title: Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location: Remote within North Carolina POSTING DETAILS: Make an Impact Trillium Health Resources is...Remote workFull timeWork at officeLocal areaImmediate startWork from homeFlexible hours- ...Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes, and reconsiderations to ensure... ...with state and NCQA requirements while working remotely. Key responsibilities Perform data entry to track, log...Remote workFull timeVisa sponsorshipWork visa
- ...Leveraging expertise in claims adjudication and risk management, the full-time remote Appeals Specialist will guide clients through the appeals process, ensuring compliance and fair decisions while collaborating with internal teams and mentoring staff. Key responsibilities...Remote workFull timeContract work
- ...accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers...Remote workFull timeContract workWork at office
- ...To support the review process of claims, the full-time Senior Appeals Specialist will conduct thorough appeals reviews of terminated or denied Short Term Disability, Long Term Disability, and Life claims, while adhering to regulatory guidelines and collaborating with...Remote workFull timeTemporary workWork experience placement
$29.7 - $31.8 per hour
## Acute Coding Appeals SpecialistApply: Remote - Nationwide: Full time: Posted Today: R052289**Thank you for considering a career at Ensemble!*... ...70 - $31.80 based on experienceThe Acute Coding Appeals Specialist integrates medical coding principles and objectivity in...Remote workFull timeTemporary workWork at officeLocal area$19.13 - $34.17 per hour
...Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal,... ...And Mentor Less Experienced Appeals Specialists. JOB REQUIREMENTS: * High School... ...plan. This position may be performed remotely from anywhere within the continental United...Remote work$44.72k - $71.76k
...40 Compensation: Salary Range: $21.50 - $34.50 Union Position: No Department Details Fully Remote Position Summary Facilitates the denial and appeal process through exercising clinical expertise and clinical by reviewing medical records for medical necessity...Remote workFull timeImmediate startShift workDay shift$50k - $60k
...funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members. The Appeals & Disputes Specialist is responsible for reviewing, investigating, and resolving member appeals and provider disputes for benefit plans,...Remote workFull timeWork at office- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
- ...Centene Corp. is seeking a Grievance & Appeals Coordinator I for a remote KS role. You will analyze and resolve member and provider grievances and appeals, prepare formal responses, and maintain detailed case files in a fast-paced environment. The role requires a high...Remote workFlexible hours
- Appeals Specialist# Appeals SpecialistFully Remote • Allied Benefit Systems - CHICAGO, IL 60606## OverviewSalary Range$20.00 - $21.00 HourlyPosition TypeFull TimeCategoryClaims## Description**POSITION SUMMARY**The Appeals Specialist will be responsible for the organization...Remote workWork experience placementWork from home
- Harbor Health in Texas seeks an Appeals & Grievances Specialist to investigate, process, and resolve member and provider complaints, grievances, and appeals. This fully remote role focuses on Texas IFP/Marketplace and large-group products, ensuring timely investigations...Remote job
- Elevance Health, Inc. seeks a Sr. SCA Appeals Representative to investigate and review customer appeals regarding service provision and... ...counsel, and ensures timely resolution, with strong knowledge of benefits contracts and Medicare #J-18808-Ljbffr Elevance Health, Inc.Remote job
- AHCCCS in Phoenix seeks an Advocacy Program Specialist to deliver Special Assistance for... ...protect rights while navigating grievance and appeals processes. The role requires travel within the Phoenix area and possible remote work based in the Phoenix Metropolitan area...Remote job
- Banner Plans & Networks in Arizona seeks a Grievance and Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes in a remote setting. Candidates must reside in Arizona; you will document findings...Remote job
- CredSpun LLC is seeking a remote Denial Management Specialist to tackle medical claims denials and write persuasive appeals. You will triage denials by CARC/RARC codes, payers, and deadlines, then correct and resubmit claims for front-end and coding errors. You will craft...Remote job
- Centene Corp. is seeking a remote Grievance & Appeals Coordinator II for Centene Pharmacy Services. You will analyze and resolve member and provider grievances and appeals, coordinating with internal teams and health plan partners, while ensuring regulatory compliance....Remote job
$56.27k - $69.9k
...accommodation or an alternative application process. Appeals and Grievances Full Time Professionals *... ...Pay Plan Title: Appeals or Grievances Specialist II FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location: Remote within North Carolina POSTING DETAILS...Remote workFull timeWork at officeImmediate startWork from homeFlexible hours
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