Appeals & Grievance Coordinator Position Available In Greene, Missouri

Appeals & Grievance Coordinator Quantum Recruiters Springfield, OR, US 6 days ago Quick Job type Full-time Quick Job description Job Description Summary Coordinate the internal appeals and grievances process by supporting entry of requests in a meaningful and timely manner. Provide support as needed for the completion of appeals and grievances. Communicate information about appeals and grievances processes and outcomes to members and providers verbally and / or in writing. Support member and provider experience.

Essential Responsibilities :

Oversee and coordinate all Appeal activities, ensuring response deadlines are met by applicable best practices, state and federal guidelines. Draft and provide acknowledgements by applicable method, to inquiries and appeals as required by regulations, policy and department process standards. Ensure accurate and complete entry of case-specific information into the Health Management Platform. Review the original adverse benefit determination and provide information in the case to inform further processing. Prepare and provide responses and resolution by applicable method to inquiries and appeals as required by regulations, policy and department process standards. Collaborate with team members to manage the timeliness of cases. Identify needs of the case spanning Commercial, Medicaid, and Medicare plans based on applicable state, federal, and NCQA guidelines.

Supporting Responsibilities :

Assist the Appeals and Grievances Support team in the entry of new appeals and grievances into the system. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.

SUCCESS PROFILE

Work Experience :

Minimum of two years of customer service, claims processing, or health insurance industry experience required. 1 year of technical writing and conflict resolution experience preferred.

Education, Certificates, Licenses :

High School Diploma required; bachelor’s degree or equivalent experience preferred.

Knowledge :

Requires strong research, analytical, and data entry skills. Experience using Facets, Onbase, and other software packages. Must have basic math skills, the ability to work under strict deadlines, and excellent organizational skills. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards a job alert for this search Grievance Coordinator

• Springfield, OR, US Related jobs Audit & Reimbursement III
• Appeals Elevance Health

W RUSSELL RD,LAS VEGAS,NV

Full-time Location :

This is a United States based, virtual position.

Elevance Health’s family of brands.

We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid S…

Show more Last updated:

30+ days ago Promoted Life Enrichment Coordinator (Activities Coordinator) Cedarhurst Senior Living Springfield, IL, US Full-time Cedarhurst, a regional healthcare provider and true friend of older adults, seeks a service-minded, career-oriented individual to join our team as a.
Life Enrichment Coordinator (Activities Coordina…

Show more Last updated:

30+ days ago Compensation Coordinator CoxHealth Springfield, MO, United States Full-time About Us CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas.

The organization includes six hospitals, 5 ERs, and over 80 clinics.

CoxHealth h…

Show more Last updated:

4 days ago Care Coordinator

• Appeals CareCentrix Remote, US Remote Full-time Quick The Care Coordinator
• Appeals is responsible for supporting health plan, physicians and member requests related to appeals, and scheduling peer to peer conversations.

You will be responsible for tr…

Show more Last updated:

30+ days ago Medicare Grievance Customer Service Lead Representative

• Cigna Healthcare
• Remote The Cigna Group United States Work at Home Remote Full-time The Grievance team manages Cigna Healthcare
• Medicare / Medicaid grievances that are presented by our member’s or their representatives pertaining to the authorization of or delivery of clinical and.

..

Show more Last updated:

30+ days ago Grievances and Appeals Analyst

• Hospital Customer Service 9012 7SolutionsUSA Tennessee, US Full-time Grievances and Appeals Analyst
• Hospital Customer Service 9012.

This is a contract job opportunity.

Position :

Grievances and Appeals Analyst

• Hospital Customer Service 9012

Location :

Remote

• must r.

..

Show more Last updated:

30+ days ago Promoted TTAC Coordinator George Mason University Prince William, VA, United States Full-time Administrative or Professional Faculty .Col of Ed and Human Development.

Administrative or Professional Faculty.

Salary commensurate with education and experience.
The Training and Technical Assistanc…

Show more Last updated:

30+ days ago Promoted Care Coordinator Behavioral Health Network Springfield, MA, US Full-time Make an Impact as a Care Coordinator

• Empowering Families, Supporting Youth!

.Are you passionate about helping youth and families navigate challenges and achieve their goals? As a Care Coordinator …

Show more Last updated:

9 days ago New! Appeals and Grievance Specialist VirtualVocations Springfield, Ohio, United States Full-time A company is looking for a Member Appeals & Grievances Specialist

• Remote EST.

Key Responsibilities Review and resolve member disputes, complaints, and grievances in accordance with regulatory st…

Show more Last updated:

12 hours ago Appeals Coordinator I MedReview US Full-time Quick Appeals Coordinator Level I Position Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.
As such, we are a leading authority in payment int…

Show more Last updated:

30+ days ago Senior IT Analyst, AMP Home Depot AT, US Permanent AMP associates review areas of controllership, perform risk assessments and evaluate business / operational processes to identify process improvement / cost-out opportunities and mitigate risks.

The Sen…

Show more Last updated:

30+ days ago Promoted Transportation Coordinator

PARAGON PROFESSIONAL SERVICES LLC

Springfield, MA, US Full-time Paragon Professional Services, LLC, is currently seeking a highly qualified Transportation Coordinator to support three site locations in the New England area (Burlington MA, Harford CT and Dover N…

Show more Last updated:

30+ days ago Coordinator, P2P Appeals CorroHealth Remote US Remote Full-time Our purpose is to help clients exceed their financial health goals.

Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs.

Enabling our teams wit…

Show more Last updated:

30+ days ago

OFFICE COORDINATOR

City of Springfield, IL Springfield, IL, United States Full-time Job Standards The Office of Public Utilities, Regulatory Affairs Division is seeking an individual to plan, direct and perform a variety of complex, specialized technical and administrative duties…

Show more Last updated:

12 days ago Promoted Referral Coordinator Caring Health Center Inc Springfield, MA, US Full-time Graduated from accredited school, and High School diploma / G.Ability to establish and maintain effective working relationships with other employees, patients, representatives of outside agencies and…

Show more Last updated:

23 days ago Promoted Logistics Coordinator QE Solar Springfield, NJ, US Full-time QE Solar is seeking a highly organized, proactive, and customer-service-oriented Logistics, Warehouse, and Office Coordinator to support front office operations and small warehouse functions for ou…

Show more Last updated:

30+ days ago Promoted

QUALITY COORDINATOR

Universal Health Services, Inc. Springfield, IL, United States Full-time Director of Risk / Quality Management & Compliance Officer, all quality / performance improvement-related processes within the hospital.
Performance improvement activities include but are not limited to…

Show more Last updated:

24 days ago RN Analyst, Appeals BlueCross BlueShield of South Carolina South Carolina Full-time This position is full time (40 hours / week) Monday-Friday, 8 : 30 am

• 5 : 00 pm and will be located at.

This role is eligible to work remotely after training (3-4 weeks).
Must be able to travel to the Co…

Show more Last updated:

30+ days ago