- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible for providing comprehensive responses in compliance with contract, regulatory and accreditation ... during the administrative hearing process. Works closely with the Compliance Officer and is an active member of the...communicate disposition of case . + Triages case inquiries, appeals , and prepares case files/packets for appeal hearings. Attend… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... as well as other internal and external partners to ensure a comprehensive appeals management process. Job Description Specialist II Key Outcomes: + Serves… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (ALD) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...judgment. This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS),… more
- Commonwealth Care Alliance (Boston, MA)
- …as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...Grievances team in a number of ways to ensure compliance on activities related to member complaints in the… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... (MA), or Select Health. Ensures regulatory compliance , timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines. * Collaborates with managed care department… more
- LA Care Health Plan (Los Angeles, CA)
- …and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on ... Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department:...performance, trains, coaching, mentoring, motivating, and ensures compliance to policies, procedures and regulations. Ensures that… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures (both ... APR-DRG, identify missed secondary diagnoses and procedures, PSIs, HACs and ensures compliance with all DRG mandates and reporting requirements. Analyzes reports and… more
- State of Colorado (Grand Junction, CO)
- Compliance Specialist - Grand Junction Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4653245) Apply Compliance Specialist - ... are 26 biweekly pay periods in a year. The Compliance Specialist Administrator II classification s tarting...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more