Grievance and Appeals Coordinator I
$19.43 - $32.98 per hourCentene Management Company LLC
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Location: Position is remote. Must live in Arizona. Position Purpose Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail Performs other duties as assigned Complies with all policies and standards Education/Experience High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience. Pay Range $19.43 - $32.98 per hour Benefits Competitive pay Health insurance 401K and stock purchase plans Tuition reimbursement Paid time off plus holidays A flexible approach to work with remote, hybrid, field or office work schedules Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well. #J-18808-Ljbffr
$22 - $23 per hour
...Immediate need for a Grievance & Appeals Coordinator . This is a 12+ Month Contract opportunity with long-term potential and is US ( Remote ). Please review the job description below and contact me ASAP if you are interested. Job Diva ID: 26-07046 Pay Range: $...SuggestedContract workWork at officeLocal areaImmediate startRemote work- ...CareSource is seeking a Quality Coordinator - ESH to analyze and coordinate quality and regulatory activities related to member grievances and appeals, ensuring compliance with federal, state, contractual, and organizational requirements. The role involves investigating...Suggested
- Harbor Health seeks an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function across Texas markets, ensuring CMS/TDI/NCQA compliance and timely resolutions. You will manage a team, collaborate with Compliance, Legal, Claims,...Suggested
- Harbor Health is seeking an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function. In this role... ...Medical Directors on clinical appeal reviews, including coordination of peer-to-peer and independent review organization (IRO) referrals...Suggested
- 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
$30 - $35 per hour
...Now Hiring: Grievance & Appeals Specialists Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid Managed Care? We're partnering with a leading healthcare organization that's looking to add multiple specialists to their growing...Work at officeImmediate start- ...to handle department correspondence, log and route mail, and provide back-up support to coordinators and the director. The role emphasizes timely processing of grievances and appeals within regulatory timeframes. Responsibilities include opening and date-stamping mail,...
- ...to help keep people independent and living life on their own terms. The RN Coordinator will investigate and respond to written and/or verbal clinical appeals, expedited clinical grievances and potential quality of care grievances submitted by members and providers in...Contract work
- The Bronx District Attorney's Office is looking for an experienced attorney to manage post-conviction litigation. This role involves representing the People of the State of New York in appellate litigation, handling complex legal issues, and requires a Juris Doctorate ...Work at office
$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work$22 per hour
Overview The Prior Authorization Coordinator will facilitate the logging in and out of all prior authorization, appeal, reimbursement and grievance requests, and follow-up on requests to ensure that all are resolved and completed in a timely manner. The coordinator will...Hourly payTemporary work- Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations...Remote work
- ...providers where necessary. Verify medical benefits and facilitate the prior authorization process for company products. Coordinate the pre-service appeals process, including composition of appeals. Establish strong relationships with referring rheumatology practices,...Remote work
$71.59k - $116.48k
A prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case management, understanding of regulatory compliance, and the ability to effectively resolve...Remote job$68k - $75k
...ResponsibilitiesWhat You'll DoAs part of the DGA's contracts team, the Contracts Coordinator is responsible for administering the DGA's agreements, which... ...themIf necessary, pursuing violations through the contract grievance process, working with colleagues in Los Angeles to ensure...Contract workWork at office$20 - $30 per hour
...collaborating in advance with the primary treating clinicians. Coordinate Peer-to-Peer (P2P) Review preparation and assist with scheduling... ...Authorization Required (NAR) requests. Establish post denial appeal response recommendations. Obtain portal access to any utilization...Remote work$17.5 - $18.5 per hour
...together towards our shared purpose. Job Summary The Practice Coordinator is responsible for managing the front office daily activities... ...patient chart is prepared. General office duties, cleanliness, and appeal, such as sorting office mail, scanning documents, e‑faxes,...Full timeTemporary workWork at officeLocal areaRemote work- ...Denials Management Specialist to join our remote team. This role focuses on inpatient CMS denials, medical necessity reviews, and appeals for insurance payers. You will collaborate with Case Management and Billing to improve denial workflows and maximize timely reimbursements...Remote work
- ...include, but are not limited to the following: Ensure unit staff has all systems needed to process Primary Residence Verification appeals for the Non-Primary Residence Surcharge and liaise with other units in the DOF, to mitigate any issues that arise. Communicate and...Permanent employmentFull timeWork at officeRemote work2 days per week
$132.02k - $156.77k
About This Role The Transplant Coordinator, Registered Nurse- Heart Transplant is a vital member of the multidisciplinary Heart Failure/... ...paperwork Complete paperwork for prior authorizations, denials/appeals Prepare information for peer to peer authorizations Monitor...Full timeDay shift$19 per hour
The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related... ...to processing Utilization Management prior authorization and appeals. JOB RESPONSIBILITIES Monitor incoming faxes Enter UM authorizations...Temporary workLocal areaRemote work- ...Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per Diem to coordinate and direct utilization review functions... ...review process for the purpose of preparing and submitting appeals to third‑party payors. Respect the confidentiality of patient...Daily paidTemporary workReliefLocal area
- Staffing Coordinator-Full Time page is loaded## Staffing Coordinator-Full Timelocations: Remote - Pennsylvaniatime type: Full timeposted... ...in which work will be accomplished.• Review complaints and grievances pertinent to scheduling and staffing. Make necessary oral/written...Full timeWork at officeImmediate startRemote work
$75.2k
...New York health care consumers and small businesses. It also coordinates the Health Care for All New York Campaign (HCFANY), a coalition... ...coverage, how to access health care through a health plan, how to appeal a denial of coverage or care, how to access low-cost or free...Temporary workLocal areaRemote work2 days per week3 days per week$46.99k - $112.2k
...Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner post-service appeals. Responsible for organization and development of high performing teams to ensure timely, customer focused response to appeals. Facilitates...Hourly payFull timeContract workTemporary workWork experience placementLocal areaWork from homeWeekend work- ...for the preparation, communication, and submission of External Appeals and QIO case files to the Department and Financial Services (... ...departmental reports. Serve as a backup for the A&G Fair Hearing Coordinator and the A&G Senior Specialists and other A&G staff as needed....
$23.51 - $29.38 per hour
The Center Coordinator, Family Business & Operations provides administrative, financial, and digital engagement support for the LMU Family... ...'s Statement of Non-Discrimination policy and related grievance procedures, click here. To report questions or concerns about...Part timeFixed term contractWork at officeLocal area$29.33 per hour
...Summary: The Coordinator, Advancement carries out administrative and project management functions in support of the ASPCA’s Advancement fundraising teams, including Corporate Partnerships, Foundation Partnerships, and Major Gifts. The individual in this role communicates...Hourly payFull timeTemporary workWork experience placementWork at officeLocal areaRemote workWork from homeFlexible hoursAfternoon shift- ...environment. Key Responsibilities Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims Process a high volume of detailed account information accurately and within established performance guidelines...Full timeWork at office
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