appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the... point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. Ensure...
representatives maintain compliance with CMS standards in documentation and grievance follow up . Serves as the lead person for the... Conditions of Participation related to patient grievance management.(This is a responsibility that by CMS standards is given...
relations to ensure that patient representatives maintain compliance with CMS standards in documentation and grievance follow up... that the hospital is in compliance with CMS Conditions of Participation related to patient grievance management...
Anticipated End Date: 2025-02-14 Position Title: Grievance/Appeals Analyst I (California... Only) Job Description: Title: Grievance/Appeals Analyst I Location: This position will work a remote model. Ideal candidates will live within 50...
skill set. Administer ongoing grievance tracking, trending, and reporting for assigned grievances. Review incoming appeals... and grievances and determine which area to assign case to or reroute if the issue does not meet appeal or grievance criteria. Work...
Anticipated End Date: 2025-02-14 Position Title: Grievance/Appeals Analyst I Job Description: Title: Grievance... miles of one of our PulsePoint locations. The Grievance/Appeals Analyst I is an entry level position in the Enterprise...
Specialist explains the grievance process to all parties and provides information and referrals to callers for whom a grievance... and completes the grievance process within established deadlines. The LCFAS completes and submits all required monthly, quarterly...
Summary of Position Perform clinical and administrative reviews within the Grievance and Appeals department, ensuring... processes designed to manage utilization within the benefit plan. Responsible for the review of grievance and appeal cases...
STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING! Strategic Staffing Solutions is currently looking for a Grievance...: Grievance & Appeals Coordinator Location: Detroit, MI (Fully Remote) Duration: 12+ Months Role Type: W2 Contract Engagement...
STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING! Strategic Staffing Solutions is currently looking for a Grievance...: Grievance & Appeals Coordinator Location: Detroit, MI (Fully Remote) Duration: 12+ Months Role Type: W2 Contract Engagement...
Anticipated End Date: 2025-02-03 Position Title: Manager II Grievance/Appeals (RN) Job Description: Manager II... Grievance/Appeals (RN)– Claims Support Location: This position will work in a hybrid model (remote and office). Ideal...
Job Description: PRINCIPAL RESPONSIBILITIES: Under general direction of the Grievance and Appeals Leadership, the... Grievance and Appeals (G&A) Coordinator II will review, investigate and process non-complex grievances for all lines of business...
representatives maintain compliance with CMS standards in documentation and grievance follow up . Serves as the lead person for the... Conditions of Participation related to patient grievance management.(This is a responsibility that by CMS standards is given...
relations to ensure that patient representatives maintain compliance with CMS standards in documentation and grievance follow up... that the hospital is in compliance with CMS Conditions of Participation related to patient grievance management...
Overview: Represents PHC in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating..., and resolving assigned member grievance and appeal cases ranging from low to high complexity. Works to transform member...
Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received...
and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member... to CMS, MassHealth, DHHS and the Connector Authority, as needed Complaint/Grievance Responsibilities: Coordinates...
Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received...
and Grievance unit, with a high level of productivity to achieve the department's overall performance metrics, and to meet... and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely...
JOB SUMMARY Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational... aspects, of the member and provider complaints, appeals and grievance cases for products for all lines of business...