Provider Appeals
2 days ago
Provider Appeals & Grievances Specialist (Remote)This is a remote position open to any qualified applicant that lives in the United States. We are seeking a dedicated Provider Appeals & Grievance Specialist with 1 to 2 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel, knowledge/navigation skills for Microsoft programs in a fast-paced, production-driven environment and dedication to attendance adherence. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position with day hours, and no travel is required. Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.Basic qualifications:2 years of Appeals and Grievance1 Year of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider's office)Medicaid & Medicare insurance customer service or claims processing2 Years of medical health insurance (Must be with a managed healthcare plan, not on behalf of provider or provider's office), Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMSBilling and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances, processes, resolutions, compliance TATSelf-resolved troubleshooting ability for various IT issuesKnowledge of QNXTKnowledge of PEGAKnowledge of SharePointSense of urgency with production and responsiveness to email and MS TeamsAbility to create and fax written communication in a professional manner including spelling and grammarSalary and Other Compensation: Applications will be accepted until December 11, 2025. The hourly rate for this position is between $17.00 18.00 per hour, depending on experience and other qualifications of the successful candidate. This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans.Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:Medical/Dental/Vision/Life InsurancePaid holidays plus Paid Time Off401(k) plan and contributionsLong-term/Short-term DisabilityPaid Parental LeaveEmployee Stock Purchase PlanDisclaimer: The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law. Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
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Specialist, Appeals
6 days ago
Augusta, United States Georgia Staffing Full timeJob SummaryResponsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.Knowledge/Skills/Abilities:Responsible for the comprehensive research and resolution of...
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Senior Pharmacy PA/Appeals Technician
3 weeks ago
Augusta, United States Maine Staffing Full timeSenior Pharmacy PA/Appeals Technician Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture...
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Account Resolution 2 MGBO WMCG
6 days ago
Augusta, Georgia, United States Wellstar Health System Full timeHow would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the...
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Augusta, Georgia, United States Evolve Managed Care Solutions Full timeAbout Us: Evolve is a trusted psychiatric and behavioral health service provider committed to delivering high-quality mental health care to our patients. We are seeking an experienced Mental Health Billing Specialist with expertise in denials management, insurance credentialing, verification, and experience with eClinical Works. This role is essential to...
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Augusta, United States Brine Group Staffing Solutions Full timeId : 7529 Category : Physician Location/City : ME - Augusta Salary Range : 0.00 - 0.00 per year (Permanent) Job Type : Permanent Recruiter Email : Seeking a BC/BE Physiatrist to provide outpatient services including general rehab work: pain management, and electrodiagnostics, Interventional skills a plus. Will be assisting with multidisciplinary development...
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Augusta, United States Brine Group Staffing Solutions Full timeId : 7529 Category : Physician Location/City : ME - Augusta Salary Range : 0.00 - 0.00 per year (Permanent) Job Type : Permanent Recruiter Email : Seeking a BC/BE Physiatrist to provide outpatient services including general rehab work: pain management, and electrodiagnostics, Interventional skills a plus. Will be assisting with multidisciplinary development...
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Augusta, United States Brine Group Staffing Solutions Full timeId : 7529 Category : Physician Location/City : ME - Augusta Salary Range : 0.00 - 0.00 per year (Permanent) Job Type : Permanent Recruiter Email : Seeking a BC/BE Physiatrist to provide outpatient services including general rehab work: pain management, and electrodiagnostics, Interventional skills a plus. Will be assisting with multidisciplinary development...
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Bartender - Carolina Ale House
2 weeks ago
Augusta, Maine, United States Food People Restaurant Group Full time $25,000 - $40,000 per yearCarolina Ale House is seeking experienced Bartenders to join our team in Augusta, GAResponsibilities:Provide menu knowledge and suggest drink options to guests, ensuring a memorable experience.Comply with all alcohol service laws and regulations to ensure responsible alcohol consumption.Practice safe alcohol service by monitoring guest alcohol consumption...
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Customer Service Representative
6 days ago
Augusta, United States Maine Staffing Full timeCustomer Service Representative At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000...
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Budtender at Landrace Cannabis
2 weeks ago
Augusta, Maine, United States Landrace Cannabis Company Full time $28,000 - $42,000 per yearJob Summary:Landrace Cannabis is seeking a Budtender to join our dynamic team for a store in Hallowell, Maine. The ideal candidate will have cannabis knowledge to assist customers in selecting suitable cannabis products and provide exceptional service in a dispensary setting. Current IIC card a plus.Responsibilities:- Greet and assist customers in a...
