to several different issues. The Clinical Appeals Representative needs to be able to distinguish between Quality of Care, Appeal... for setting up the Appeals and Grievance cases for the Coordinators, Nurses and Doctors to review for a determination of denial...
is required Research and resolve written complaints submitted by member or authorized representative Render decision for non - clinical... standards Review Member Appeals based on internal procedures following Department of Labor Guidelines Request medical records...
. The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing..., researching, investigating, negotiating and resolving all types of appeals and grievances. This position is full-time (40 hours...
. The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing..., researching, investigating, negotiating and resolving all types of appeals and grievances. This position is full-time (40 hours...
to several different issues. The Clinical Appeals Representative needs to be able to distinguish between Quality of Care, Appeal... for setting up the Appeals and Grievance cases for the Coordinators, Nurses and Doctors to review for a determination of denial...
match) Generous PTO 8 Paid Holidays Equipment Provided for Remote Roles Overview The Appeals Representative... issues as needed and processes all appeals including Medicare, Medicaid, Blue Shield, and Commercial carriers. Essentials...
Anticipated End Date: 2026-02-13 Position Title: Grievance/Appeals Representative I Job Description: Title...: Grievance/Appeals Representative I Locations: Woburn, MA and Manchester, NH This role requires associates to be in-office 1...
appeals accordingly. Maintains accuracy and production to ensure invoices are being processed efficiently. ESSENTIAL DUTIES... AND RESPONSIBILITIES: Reviews ETM task list assignment, comments, and rebills/appeals claim as necessary Reviews denials to determine...
appeals accordingly. Maintains accuracy and production to ensure invoices are being processed efficiently. ESSENTIAL DUTIES... AND RESPONSIBILITIES: Reviews ETM task list assignment, comments, and rebills/appeals claim as necessary Reviews denials to determine...
oriented, while holding accountability to all actions. Appeals would be assigned to them all day and pivot if needed. Work.... Primary Responsibilities: Research and resolve written appeals submitted by consumers and physicians/providers Ensure...
- Friday. Primary Responsibilities: Research and resolve written appeals submitted by members and providers. Ensure appeal... by clinician is required. Render decision for administrative appeals using sound, fact-based decision making. Complete necessary...
Overview: Performs triage tasks, including intake, classification, setup, and assignment of grievances and appeals.... Additionally, provides administrative support to staff, including tasks such as clinical case file preparation for appeals...
Overview: Performs triage tasks, including intake, classification, setup, and assignment of grievances and appeals.... Additionally, provides administrative support to staff, including tasks such as clinical case file preparation for appeals...
Description : The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating... acts as a positive and professional representative of our CorVel family. The role ensures compliance with company...
SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst... appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and/or the...
Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible... per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals...
SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst... appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and/or the...
SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst... appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and/or the...
Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible... per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals...
Overview : The Supervisor – Arbitration Appeals is responsible for the oversight, management, and strategic direction... accommodation) Supervises and provides day-to-day leadership for Arbitration Closure Appeals staff, including workload management...