Remote Appeals & Grievances Specialist
Humana
- Remote job
Humana is seeking a Grievances and Appeals Representative 4 within the Internal Review Team to manage denials by reviewing clinical documentation and coordinating with clinical and internal Humana partners to validate final determinations. You will handle Level 1 appeal cases, review documentation, and collaborate with teams to finalize outcomes, while maintaining high productivity and strict confidentiality in a remote work setup. #J-18808-Ljbffr Humana
- ...of 8am-5pm Pactific Time. Essential Job Duties • Serves as team lead for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members, providers and related outside agencies. • Trains new employees and provides guidance...Remote workContract workWork at officeShift work
$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract We're hiring experienced Registered Nurses to join a leading healthcare organization in a fully remote role! Position...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- ...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, and related outside agencies to ensure that internal and/or...SuggestedContract workWork at office
- CVS Health is seeking a detail-oriented Appeals Specialist to manage intake, research and resolution of member and provider appeals, complaints, and grievances. You will coordinate responses across multiple teams, verify eligibility and benefit details, and ensure timely...Suggested
- MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation. You will determine the appropriate...Suggested
- CVS Health is seeking an Appeals/Grievances Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. The role requires coordination across business units, analysis of benefit language, and timely, customer-focused...
- The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for... ...ensure accurate benefit interpretations. This role offers full remote work across the United States, with limited in-office...Remote jobWork at office
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote workHourly payFull time$29.32 - $36 per hour
...Job Description Job Description Appeals and Grievances Specialist Location: Los Angeles, CA Onsite Flexibility: Hybrid Contract Details Position Type: Contract Contract Duration: 3 months (extensions available) Pay Rate: $29.32 $36.00 / Hour (USD...Contract workLocal areaWork visaShift workDay shift$83.1k - $120.36k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances... ...compliant manner. The A&G Clinical Specialist is the subject matter expert... ...participating providers. This is either a remote or on-site position located at either...Remote workContract workTemporary workWork experience placementLocal area- ...receiving behavioral health treatment. UR Specialists also interpret, advise and train staff... ...eligible list. The option for hybrid remote work may be available based on the... ...regarding client’s rights; topics such as grievances, appeals or sentinel events/incident reports....Remote workContract workLocal areaTrial periodFlexible hours
- ...Remote Appeals Pharmacist – Fair Medication Access Work From Home | Strong Clinical Writing Focus Combine clinical expertise with advocacy... ...clinical documentation for medication coverage appeals and grievances. Apply plan policies, evidence-based guidelines, and...Remote workWork from home
- ...Medi-Cal Appeals And Grievances Rn SeniorThe Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medi-Cal Appeals and Grievances...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- ...Revenue Management Team as an eBilling Specialist We are seeking a highly skilled professional... ...out of one of our U.S. GT offices, on a remote basis. This role reports to the Director... ...eBilling issues, manage rejections, appeals and budgets, and ensure compliance with...Remote workFull timeWork at officeLocal areaShift work
- ...events, the full-time Senior Purchasing Specialist will manage creative program development... ...procurement, and negotiation, while working remotely. Key responsibilities Coordinate large... ...team members and suppliers Develop appealing programs that maximize client budgets while...Remote workFull timeWork at office
$39.52k - $47.84k
...Arundel Dermatology is seeking a full-time Accounts Receivable Specialist (AR Specialist) to join our Revenue Cycle team. This remote position is responsible for insurance follow-up, denial resolution, appeals, and collections activities related to open accounts...Remote workFull timeTemporary workMonday to Friday$100k - $160k
.... Job Description: Senior Biology Specialist TaskUs partners with pioneering technology... ...ensure consistency across the pod. Appeals & Policy Enforcement: Evaluate customer... ...: US (Texas preferred) Work Setup: Remote Type: Full time Salary Range: $1...Remote workFull time$25 - $30 per hour
...The AR Follow-Up Specialist is responsible for timely and accurate follow-up of outstanding... ...strategies across all payer types. *This is a remote role. We are only hiring in the... ...partners Identify opportunities for appeal when claims are underpaid or incorrectly...Remote workHourly payFor contractorsWork at officeMonday to Friday- ...Trust & Safety Specialist Welo Data, a Welo Global brand, is the multilingual data and evaluation partner for foundation labs and enterprises... ..., evidence-backed case notes that would survive an audit or an appeal. ~ Comfort with ambiguity and volume — you can prioritize a...Remote work
- ...AR Specialist At Zotec Partners, our people make it happen. Transforming the healthcare... ...an AR Specialist to join us. This is a remote position. What you'll do: Follow up... ...work files Process and follow up on appeals Resolve correspondence issues What...Remote work
$16 - $26 per hour
...Recovery Specialist Payment Poster Owings Mills, MD PRACTICE DYNAMICS, INC. LBH PARTNERS REV... ...DC, PA, VA OR WVA POTENTIAL FOR HYBRID REMOTE! JOB SUMMARY: The Medical Billing Collector... ...and payment variances, completing appeals, with the goal of maximizing collections...Remote workFull timeDay shift$80k
...Location: This is a remote position, but candidates will happy to work on either EST or... ...Pharmaceuticals is recruiting for two Access Specialist's to join our growing Metabolic team... ...obtain prior authorizations and support appeals processes. As part of your role, you’ll...Remote work- ...Pinterest Ads Specialist Sarajevo, Federation of Bosnia and Herzegovina, Bosnia and Herzegovina... ...join their vibrant team for a full time remote job. At Pinclever, we're a thriving... ...and KPIs. Develop visually appealing Pinterest ad campaigns with engaging content...Remote workFull time
$18.99 - $29.22 per hour
...Precertification Specialist Join RCCA and make a meaningful impact on the patient journey. As a fully remote Precertification Specialist, you will be responsible for obtaining... ...or denied authorizations, submitting appeals when necessary Resolves any issues or...Remote workFull timeTemporary workFlexible hours- ...Case Manager - Utilization Review Specialist - Remote Full-Time Position You must reside in one of these states to be eligible for position... ...the prevention of denials from all payers, as well as appeals of all accounts reviewed and deemed appropriate for appeal....Remote workFull time
$26 - $29 per hour
...an alternative application process. RCM Specialist III Paradigm RCM Lincoln, NE, US 2 days... ...: $26.00 To $29.00 Hourly LOCATION: REMOTE HOURS: 8-5, M-F ROLE OVERVIEW The... ...follow-up on outstanding claims, denials and appeals management Credit balance resolution and...Remote workHourly pay- ...matters most: delivering quality care to their clients. As an RCM Specialist II, you will serve as a trusted partner to clinicians and... ...including claims submission, payment posting, denial management, appeals, and accounts receivable follow-up. Strong analytical and...Remote workWork at office
$27 - $30 per hour
...Immediate need for a talented Appeals & Grievances Case Manager (Oregon) . This is a 12 Months Contract opportunity with long-term potential and is located in US(Remote) . Please review the job description below and contact me ASAP if you are interested. Job ID:...Remote workContract workLocal areaImmediate start$27 - $30 per hour
...Description Job Description Immediate need for a talented Appeals & Grievances Case Manager (Oregon) . This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote) . Please review the job description below and contact me ASAP...Remote workContract workLocal areaImmediate start- ...who support patients? Revenue Recovery Specialist, MVA, is responsible for resolving motor... ...with notation databases. This position is remote and requires a dedicated, distraction-... ...Health, TPL) involved. Prepare and submit appeals with required documentation in a timely...Remote workTemporary workWork from home
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