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- Our client is seeking an experienced Grievance and Appeals Specialist with strong health plan industry experience to join their team. The Grievance and Appeals Specialist is responsible for reviewing, investigating, and resolving member and provider grievances and appeals...Suggested
$72.08k - $151k
The Manager Grievance & Appeals will provide leadership and manage the staff and departmental activities of the Grievances & Appeals Department. The role will be responsible for planning and ensuring the efficient operating and adherence to organizational and multiple state...SuggestedWork at officeLocal areaVisa sponsorshipWork visa- ...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 agencies to ensure that internal and/or...SuggestedContract workWork at office
$191.5k - $355.6k
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest...SuggestedFull timeWork at officeRemote workWork from home$248.5k - $373k
...responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing togetherWork at home!The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for...SuggestedMinimum wageWork experience placementLocal areaRemote work$238k - $357.5k
...responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Work at home!The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for...SuggestedMinimum wageWork experience placementLocal areaRemote workWork from home$236.5k
...patients, collaborating with care management teams to optimize outcomes.Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.Participates in provider network...SuggestedFull timePart timeWork at officeRemote workFlexible hoursWeekend work$66.58k - $142.58k
...to simplify health care one person, one family and one community at a time. Position Summary CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate resolution of...SuggestedHourly payFull timeTemporary workLocal areaRemote workMonday to FridayShift work$48.08 - $57.69 per hour
...an existing Fisher Phillips office)Fisher Phillips, a premier international labor and employment law firm, is seeking an Insurance Appeals Specialist to join our Legal Project Management Team. This role is responsible for managing, researching, interpreting, and drafting...SuggestedHourly payFull timeWork at officeRemote workRelocation- ...Appeals Coordinator Responsible for clinically assessing all adverse determinations made by insurers through all levels of the appeals process. Education Other Graduate of an accredited school of nursing Required Experience General Experience and knowledge of InterQual...Suggested
- Overview: Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and required documentation to the state within the filing time limits...SuggestedRemote work
- ...Kingdom. Position Summary This position is responsible for monitoring insurance denials by running relevant reports and documenting appeal results in MS4 and MIDAS, ensuring proper notification to providers and members. The individual oversees staff handling post-...SuggestedWork experience placementLocal areaRelocation package
- NYC based Prestigious legal services firm seeks an E-Billing Analyst to join their team! Responsibilities Prepare and submit appeals for rejected invoices. Logging reduced invoices for all clients. Following up with firm timekeepers to prepare for appeal replies. Negotiating...Suggested
- The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies. The Coordinator is expected to analyze the customers’ concerns, conduct necessary...Suggested
$11 - $13 per hour
...Toll Free: (***) ***-**** Facebook page opens in new window YouTube page opens in new window Linkedin page opens in new window The Appeals department is the backend for when an insurance hasn’t paid a medical claim correctly, or hasn’t been processed correctly based on...SuggestedContract workWork at office- ...denied claims by identifying reasons for denial or dispute and collaborating closely with Nurse Auditors to support medical necessity appeals. This position requires preparing and submitting accurate appeal documentation, conducting thorough research to gather supporting...Work at officeLocal area
$22 per hour
We are seeking an Appeals & Grievances Coordinator to join The Hollister Group, a leading women-owned staffing firm in the Boston area. This role is remote with a compensation of $22/hr . Responsibilities: Coordinate appeals and grievances activities Track all member appeals...Contract workRemote work- Job Overview OrthoMed Anesthesia, located in Addison, TX, is seeking a detail-oriented Appeals Specialist. The role is full-time and requires on-site presence during regular business hours at our corporate office. Key Responsibilities Review denied claims and determine...Full timeWork at office
- ...Job Title Job Description Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case...Contract workApprenticeshipLocal areaRemote work
- Are you an experienced healthcare professional with a background in Managed Care, Appeals & Grievances, and Claims Review ? We are seeking a detail-oriented Appeals & Grievance Specialist II to join a leading health plan and support member and provider issue resolution....
- ...today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Are you an experienced Medical Appeals Specialist in the Tacoma, WA area seeking a great career opportunity? Have you recently been seeking out prestigious, national healthcare...Hourly payContract workPrivate practice
$52k - $58k
...Appeals Analyst Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life from grade school to college...Temporary workWork experience placementCasual workWork at officeFlexible hours$53k - $65k
...Job Description Job Description Appeals Coordinator (Healthcare Revenue Cycle) This role plays a critical part in maximizing reimbursement and protecting revenue through expert-level appeals and payer negotiations. What You'll Do Maximize reimbursement by...Local areaLHH US
Tempe, AZ12 days ago- ...Appeals Supervisor The Appeals Supervisor oversees day-to-day operations of the administrative (non-clinical) appeals. This role ensures timely, accurate, and compliant processing of member and provider administrative appeals in accordance with NCQA standards, contractual...Work at office
- ...Remote Appeals Pharmacist Fair Medication Access Work From Home | Strong Clinical Writing Focus Combine clinical expertise with advocacy in a fully remote Appeals Pharmacist role. Review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations...Remote jobWork from home
- ...Appeals Clinical Specialist The Appeals team oversees all operational and clinical aspects of the appeals process, including intake, case processing, clinical determinations, notifications, and compliance with regulatory and accreditation standards. The Appeal Clinical...Full timeWork at officeLocal areaRemote workMonday to FridayNight shiftWeekend work
$24 - $25 per hour
...M&R Appeals Coder Wipro Limited is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design,...Minimum wageLocal area$19.43 - $32.98 per hour
Position Purpose and Key Details Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship...Hourly payFull timePart timeH1bWork at officeRemote workFlexible hours$40.87 - $80.43 per hour
...Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision Provide...Remote jobHourly payWork experience placement$128k - $160k
...Supervisor, Appeals Pharmacist Charlotte, North Carolina, United States; Denver, Colorado, United States; New York, New York, United States About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions...Contract workWork at officeLocal areaRemote workMonday to FridayFlexible hoursShift workWeekend work
