Medicaid Appeals & Grievances Specialist
Molina Healthcare
At Molina Healthcare, the Claims Appeals Specialist provides support for handling member and provider complaints, aligning with CMS standards and regulatory requirements. The role focuses on researching and resolving appeals, disputes, and grievances with timely communications to authorized representatives. The position emphasizes navigating Medicaid/Medicare guidelines, reviewing records, and producing clear appeal summaries. #J-18808-Ljbffr Molina Healthcare
- ...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, and related outside...SuggestedRemote jobContract workWork at office
- ...A-Line Staffing Solutions in Georgia is seeking a Grievance & Appeals Coordinator I to manage the grievance and appeals workflow in a regulated environment. You will review, process and coordinate cases across teams to ensure timely, accurate outcomes. This hybrid role...SuggestedWork at officeRemote work
- Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...SuggestedRemote jobWork 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...SuggestedRemote work
$26.99 per hour
We are currently seeking experienced Appeals & Grievances Specialists! This is a full remote opportunity paying $27/hr. The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints. Experience in ACA is a plus. If...SuggestedHourly payPermanent employmentTemporary workWork experience placementRemote workShift work- Jobgether SRL in the United States is seeking an Appeals Specialist I to research and resolve member and provider appeals, disputes, and reconsiderations... ...The role requires knowledge of healthcare claims, Medicare/Medicaid rules, and strong written and verbal communication to...Remote job
$51k - $74.88k
...The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals for all of HFs line of businesses which include commercial Medicaid dual enrollments Medicare and complete care. Appeals Specialist is the subject matter expert responsible for non...Full timeTemporary workWork experience placementRemote work$90.58k - $114.59k
Position InformationNY HELPS: No55-b/c Eligible: NoAgency: Medicaid Inspector General, NYS Office of the Title: Investigative Specialist 2 MedicaidOccupational Category: No PreferenceSalary Grade: 23Bargaining Unit: PS&T - Professional, Scientific, and Technical (PEF)Salary...Permanent employmentFull timeWork experience placementInternshipWork at officeRemote workVisa sponsorship- Aspirion is seeking a Denials Appeals Specialist to analyze denial reasons, draft and submit appeals, and support improved cash flow. You will work with carriers and internal teams to resolve claims and minimize revenue leakage. Ideal candidates bring strong analytical...Remote job
- ...Medicaid Eligibility Verification Specialist The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty...Full timeWork at office
- TITLE : Entitlement Medicaid Specialist (Part-Time) REPORTS TO : Director of Entitlements LOCATION : Manor: 219 East 121st St. New York, NY 10035 OUR MISSION: Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals...Temporary workPart timeWork at officeLocal areaFlexible hours
- Access Healthcare is seeking a Membership Eligibility Specialist to verify Medicaid eligibility and reconcile payments for Medicare Advantage members. This role demands meticulous attention to detail, strong analytical skills, and the ability to navigate multiple systems...
- ...Medicaid Eligibility Specialist Applicants must be permanent in the eligibility specialist civil service title. If you are hired provisionally in this title, you must take and pass the civil service exam when it becomes available, to be eligible for continued employment...Permanent employmentFull timeWork experience placementWork at office
- City of New York is seeking six Medicaid Eligibility Specialists for the Home Care Services Program Medicaid Eligibility Unit. Responsibilities include reviewing Medicaid applications and renewals for HCSP recipients, using WMS and external systems to process actions,...
- Med-Metrix is seeking a Medicaid Coordinator to support hospital clients by gathering and processing Medicaid applications for in-house and discharged patients. You will screen eligibility by phone, enroll patients, verify information, and maintain PHI in HIPAA-compliant...
$23.56 - $25.77 per hour
...Medicaid Billing Clerk It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion... .... Bill payers by inputting billing information into databases. Appeal denied claims utilizing clearinghouse or payer portal...Local area$22.15 - $24 per hour
...What You Will Do - Essential Functions The Appeals Coordinator processes and documents all... ...Labor (DOL), Centers for Medicare and Medicaid Services (CMS), Federal and State laws.... ...is responsible for assisting the Appeals Specialists with the day-to-day operations of the Appeals...Hourly payWork at officeLocal areaRemote workWork from homeHome officeFlexible hours- ...Housing Specialist The Department of Social Services (DSS) is comprised of the administrative... ...public benefits and services including Medicaid, food stamps, and cash assistance. HASA... ..., and SSI or SSD application and appeal. HIV/AIDS Services Administration (HASA...Permanent employmentTemporary workFor contractors
- ...contract negotiations and interpretation, investigation and processing of employee grievances and hospital discipline. Conducts hearings at the Corporate level, participates in arbitration appeals and maintains liaison with employee union representatives and personnel labor...Contract workWork at officeLocal areaWork from homeShift work
$22 per hour
Broadway Ventures, a United States-based firm, is seeking candidates for a temporary 6-month role that is 100% remote. Compensation is $22 per hour with training provided. Responsibilities include prioritizing workload, using OnBase and MAS to record and upload documents...Remote jobHourly payTemporary work- ...opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of... ...and respond to written and/or verbal clinical appeals, expedited clinical grievances and potential quality of care grievances submitted by members...Contract work
$130k - $170k
...Bachelor’s degree or higher. New York City | On-site $130,000–$170,000 base + bonus This opportunity should particularly appeal to someone who enjoys the front end of private equity investing: identifying businesses, opening new relationships, and creating...Full time$250k
...Hospitals , has an opportunity for an Employee and Labor Relations Specialist. PAGNY is one of the largest physician groups in New York... ...conducts and documents workplace investigations, responds to grievances, and advises site leadership on discipline and contract...Full timeContract workWork at officeLocal areaImmediate startFlexible hours- ...complaints to determine appropriate next steps, and lead or support fact-finding activities and investigations related to employee grievances and workplace concerns. Review disciplinary actions submitted by managers before issuance to ensure accuracy, consistency, and...Contract workTemporary workWork experience placementMonday to Friday
- ...new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how... ...will investigate and respond to written or verbal appeals and grievances submitted by members and providers in accordance with Contract...Contract work
$23.17 - $28.96 per hour
Medicaid Eligibility Coordinator | Hybrid paid time off, tuition reimbursement, 401(k) Overview Provides support to prospective members, members and their families including community resource planning, advocacy, skill building, linking patient/families to community resources...Work experience placementFlexible hours- Central Nursing is hiring a Business Office Medicaid Coordinator responsible for assisting with Medicaid applications, recertifications, and gathering necessary documentation. You will coordinate with clients, families and the Medicaid Supervisor to ensure accurate submissions...Work at office
$3,500 per month
OverviewThe Asset Management Specialist assists, develops, and implements best practices to the market rate, affordable, and student housing... ...insurance expirations, real estate tax schedules with date of appeals, and lender reporting equirements, etc.)Assists with ensuring...For contractorsWork at office- ...in officeQUALIFICATIONS:H.S. diploma/ GED and Certified Peer Specialist (CRPA) Certificate. Knowledge of OASAS rules and regulations and... ...of Alcoholism and Substance Abuse Services and funded by Medicaid and the NYC Department of Health and Mental Hygiene, serves people...Daily paidFull timePart timeWork at officeImmediate startFlexible hours
$42.64k - $52.41k
...Recruiting Certified Peer Specialist for Manhattan Psychiatric Center Apply fast, check the full description by scrolling below to... ...excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other...Work at officeMonday to FridayWeekend work
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