Grievance & Appeals Resolution Specialist
Digitailor
Commission on Medical Care in California is seeking a Grievance & Appeals Investigator to review, investigate, and resolve member grievance and appeal cases ranging from low to high complexity in Fairfield, Redding, Eureka, and Chico. You will transform member dissatisfaction into satisfaction, oversee the investigative process to ensure casework complies with DHCS guidelines and NCQA standards, and collaborate with the Partnership in the Grievance & Appeals Resolution team. #J-18808-Ljbffr Digitailor
- ...US Department of Labor. That is the employer’s history, not a statement about this job. Represents Partnership in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating, and resolving assigned member grievance and appeal cases ranging from...SuggestedH1b
- ...licensed nurse (RN or LPN/LVN) for a remote role aligned to Pacific Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria are met under NCQA guidelines and company policies....SuggestedRemote job
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- Healthcare IT Leaders, LLC is seeking an experienced Revenue Cycle Specialist, focusing on Epic Resolute Professional Billing workflows and complex claims management in the Los Angeles area. The role involves insurance follow-up, denial resolution, and payment posting across...
$66.9k
...conflict among residential students, hears grievances and initiates mediation. 25% - Core... ...agencies. Ensures due process, develops resolutions, assigns sanctions, and conducts follow-... ...involving misconduct; or have filed an appeal of a finding of misconduct with a previous...Full timeContract workFor contractorsLive inShift workNight shiftAfternoon shift- ...Correctional Health Care Services is hiring Analyst I/II for Mule Creek State Prison in Ione, CA. These roles support health care appeals, data tracking, and reporting to improve program delivery. Positions are 12-month limited term, in-office with potential extension,...Work at office
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...Lead Specialist, Patient Access - Specialty Operations With the nation's largest home infusion provider, there is no limit to the... ...communicate opportunities for improvement in process and recommend resolutions Supervisory Responsibilities ~ Does this position have...Monday to FridayFlexible hours- Torrance Memorial is seeking an experienced Patient Account Representative to manage revenue cycle processes including data entry, charge processing, and claims follow-up. You will address patient and insurance inquiries, monitor denials, and process refunds while ensuring...
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...eligibility list, rendering them inactive and ineligible to be hired for the position. Candidates who have been withheld may file an appeal with the California Department of Human Resources. Cutoff Dates Applications are being accepted on a continuous basis until the...Permanent employmentFull timeTemporary workTraineeshipSecond jobWork at officeLocal areaRemote workRelocationVisa sponsorshipWork visaWeekend work- ...for a Case Manager - Utilization Review Specialist based in the United States. Join a... ...reimbursement denials, and coordinate appeals to support appropriate patient care and... ...improvement initiatives, timely appeal resolutions, and more effective healthcare administration...Full timeLive inRemote work
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...intervention in the event of a crisis, both to stop the crisis and to notify when indicated, persons and agencies necessary for the resolution of the crisis; provides “on-the-spot” counseling that is both helpful to the clients and consistent with the philosophy of the...Monday to Friday$56k - $67k
...experience executing import/export shipments, including documentation, routing, carrier coordination, point-to-point movement, and issue resolution. Independently resolve complex routing and service failures, make rapid operational decisions under pressure, and elevate...Remote jobTemporary workLocal areaImmediate startMonday to FridayFlexible hoursShift work- Cedars-Sinai is seeking a Revenue Cycle Specialist II within Patient Financial Services to support commercial collections and manage claim... ...payors, updating account data, and ensuring timely, accurate resolution of outstanding balances. Candidates should have at least two...Remote job
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...firm. To learn more about Pearce visit Your Impact As an HSE Specialist , you will play a key role in advancing Pearce’s health, safety... ..., ensuring accurate classification, documentation, and timely resolution. Manage and support the driver safety program , including analysis...Daily paidFull timeLocal areaRemote workFlexible hours$94.37k
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...Personnel Technician Classification: PERSONNEL TECHNICIAN II (SPECIALIST) Salary: $4,470.00 - $5,601.00 per Month New to State candidates... ...for the position. Candidates who have been withheld may file an appeal with the State Personnel Board. Applicants who completed their...Permanent employmentFull timeWork at officeRemote work$32 - $36 per hour
...accommodation or an alternative application process. Reentry Specialist Pinegrove Growlers Amity Reentry Professional Sacramento,... ...environment. Strong and effective problem-solving and conflict resolution skills. ARC strongly encourages qualified formerly...Hourly payFull timeContract workWork experience placementLocal area$5,663 - $7,097 per month
...'s Office of Emergency Services JC-538243 - Senior Personnel Specialist $5,663.00 - $7,097.00 per Month Final Filing Date: 11/20/202... ...assigned work through completion, ensuring timely follow-up, resolution of issues, and proper documentation of actions in accordance with...Permanent employmentFull timeWork at officeLocal areaRemote workRelocationFlexible hoursNight shiftWeekend workAfternoon shift
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