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Appeals And Grievance Specialist Jobs

Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Augusta, GA, United States
Excellent organizational, customer service, and written and verbal communication skills.
Proficiency in spelling, punctuation, and grammar skills.
Perform non-medical reviews and process redetermination letters ensuring timeliness and accuracy.
Prepare unit reports, analyze, and interpret workload, and process issues utilizing various software tools.
Update letters and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.
Appeals And Grievances Analyst
By Provisions Group At Nashville, TN, United States
• Review and interpret product and benefit designs according to State and Federal regulatory requirements
Education: Associates Degree or equivalent experience in health care, conflict resolution or related field.
• Health care benefit and regulatory knowledge preferred
• 3-5 years health care or insurance experience
• Knowledge of insurance products, policies and procedures preferred.
• Requires excellent interpersonal skills in order to communicate and work with multiple constituents.
Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
Required Education: High School Diploma or equivalent
Required Work Experience: Two (2) years of job related experience (healthcare, insurance, banking or call center).
Our Comprehensive Benefits Package Includes
Eligible for up to a $2400 annual bonus.
Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
Grievance And Appeals Coordinator - Remote | Wfh
By Get It Recruit - Healthcare At Sacramento, CA, United States

Are you a skilled communicator and problem solver with a knack for clear, concise writing? We're seeking a dedicated Member Support Specialist to join our team. As a crucial link between our members ...

Grievance & Appeals Quality Assurance Specialist
By SnugZ USA At New York, NY, United States
3 years quality management experience
Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
Update current workflows and draft future workflows, incorporating regulatory requirements, quality, and efficiency within design.
Auditing, researching, analyzing and evaluating grievance and appeals data to assess compliancy between process and the corresponding CMS and DOH regulations.
Coordinate, facilitate and document audit walkthroughs.
Develop training and refresher training.
Appeals & Grievance - Rn
By Yamhill Community Care At , Mcminnville
Knowledge of Managed Care / Medicaid requirements.
Maintains confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards.
Any combination of education and experience that would qualify candidate for the position.
Health care benefit and regulatory knowledge.
Knowledge of Oregon Medicaid grievance system requirements.
Ensures resolutions are compliant and meets turnaround times requirements dictated by policies and procedures.
Appeals Specialist Jobs
By Kepro At Cary, NC, United States
Do you value care management and quality improvement?
Are you an experienced Appeals Specialist looking for a new challenge?
Excellent verbal and written communication skills.
Requires 3+ years’ customer service experience.
Previous experience in the health care industry preferred
Are you motivated, energetic, and excited to become part of the Kepro team?
Appeals & Support Specialist Jobs
By County of Dallas Tax Appraisal District At , Dallas, 75247 $32,000 - $49,653 a year
Previous customer service, appraisal office, or other office experience.
Bilingual in Spanish - (read and speak) is preferred.
Salary Range: $32,000 to $49,653 DOE
Grievance & Appeals Specialist- Remote
By EmblemHealth At New York, NY, United States
Relevant Work Experience, Knowledge, Skills, And Abilities
Additional years of experience/training may be considered in lieu of educational requirements. (R)
Excellent organization and time management skills. (R)
Experience in a managed care/compliance environment. (P)
Determine eligibility, benefits, and prior activity related to the claims, payment or service in question.
3+ years of related professional work experience. (R)
Grievance/Appeals Analyst I (Us)
By Elevance Health At California, United States
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
12898 Towne Center Drive, Cerritos, CA
3080 Bristol Street, Costa Mesa, CA
11030 White Rock Road, Rancho Cordova, CA
1121 L St., Suite 500, Sacramento, CA
2121 N. California Boulevard, Walnut Creek, CA
Specialist, Appeals Jobs
By Experis At Columbia, SC, United States
Excellent organizational, customer service, and written and verbal communication skills.
Proficiency in spelling, punctuation, and grammar skills.
50% Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
30% Prepares unit reports, analyzes, and interprets workload, and processes issues utilizing various software tools.
10% Updates letters and documents within the department when necessary.
10% May gather and prepare documentation for legal inquiries and administrative requests.
Appeals And Grievances Lead
By Gold Kidney Health Plan At United States
· Exceptional time management skills.
· Promote a provider-friendly, customer service-oriented philosophy within the Fresenius Health Partners Utilization Management department.
· Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database, presentation and email applications.
· 2 – 4 years’ related experience required
· Medicare Advantage Appeals and Grievance experience required.
· Excellent analytical and leadership skills.
Quality Assurance Specialist, Appeals & Grievance
By Alignment Health At California, United States
Produces departmental quality performance reports for management review.
2+ years of managed healthcare experience.
Knowledge of Medicare Managed Care Plans required.
Possess the knowledge of Appeals and Grievance procedures and the Centers for Medicare (CMS) regulatory compliance guidelines.
Analyzes and validates accuracy of Appeals and Grievance data according to plan business and CMS regulatory technical reporting requirements.
2+ years healthcare appeals & grievances experience, related QA experience, or training/supervisory role.
Appeals And Grievance Coordinator
By BroadPath At United States
2+ years of Medicare Appeals/Grievance experience required
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Excellent verbal and written communication skills
However, based on performance BroadPath can offer other opportunities based on availability once the contract ends.
Processing Medicare Appeals/Grievance with Medicare Part C or D experience
Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
Member Grievance & Appeals Liaison
By Commercial Solutions At , , Az
Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution
Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times
Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM
Conduct member outreach based on a variety of trends such as frequent caller data and out of network claim denials
Recommend workflows and policy as a result of Member feedback and escalation data analysis
Document appropriate client specific information in CRM
Expedited Appeals Specialist- Remote
By ConnectiCare At , New York, Ny $72,000 - $138,000 a year
Relevant Work Experience, Knowledge, Skills, and Abilities
Extensive knowledge and experience in claims, enrollment, benefits, and member contracts. (R)
Excellent prioritizing, organizing, time management, problem solving and analytical skills. (R)
Provide recommendations to management regarding issue resolution, root cause analysis and best practices.
Additional related experience/specialized training may be considered in lieu of degree requirements. (R)
Exceed median production and compliance standards for both case resolution and data requirements.
Rn Specialist-Denials And Appeals
By Ascension At , Batavia, 60510, Il
May educate case management staff and other departments regarding payer changes and denial/appeal process.
Use clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
Collaborate with managed care department to code billable items for reimbursement.
Licensure / Certification / Registration:
Hospital: Alexian Brothers Health System
Establishe and maintain positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines.
Manager Of Grievance And Appeals
By Delta Dental Ins. At , Alpharetta, Ga
Excellent organizational and time management skills, with the ability to multi-task while maintaining attention to detail.
8+ years w/Bachelor's degree; 1+ years supervisory/management
Minimum 5 years' experience in health insurance, with 3 years' experience in grievance and appeals and/or healthcare regulation and law
Strong critical thinking and analytical skills.
Strong interpersonal, written, and verbal communication skills.
Intermediate knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook etc.
Manager, Grievance And Appeals
By CareSource At , Remote $76,700 - $122,700 a year
Minimum of three (3) years of management experience is preferred
Basic experience with Call Management Systems
Strong interpersonal skills, high level of professionalism and a collaborative management style
Manage staff to ensure timely and accurate completion of tasks and issues are accomplished
Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards
Review and interpret regulatory requirements and ensure business policies and processes are in compliance
Assoc Specialist, Appeals & Grievances
By Molina Healthcare At United States
Strong verbal and written communication skills.
Enters denials and requests for appeal into information system and prepares documentation for further review.
Research issues utilizing systems and other available resources.
Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.
Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.
Determines appropriate language for letters and prepare responses to appeals and grievances.