Current jobs related to Grievance/Appeals Analyst II_ - Cincinnati - Elevance Health
-
Data Analyst
1 week ago
Cincinnati, United States Ascendum Solutions Full timeLocation Requirement: Candidate MUST be in Cincinnati, OH, and be available to work in the downtown office on a hybrid schedule (on-site Mon, Tues, Weds, remote Thurs & Fri.)We are seeking a detail-oriented Data Analyst for a 6-month W-2 contract-to-hire position. You will play a critical role in maintaining and developing business reporting functions,...
-
Data Analyst
3 days ago
cincinnati, United States Ascendum Solutions Full timeLocation Requirement: Candidate MUST be in Cincinnati, OH, and be available to work in the downtown office on a hybrid schedule (on-site Mon, Tues, Weds, remote Thurs & Fri.)We are seeking a detail-oriented Data Analyst for a 6-month W-2 contract-to-hire position. You will play a critical role in maintaining and developing business reporting functions,...
-
Data Analyst
1 week ago
Cincinnati, United States Ascendum Solutions Full timeLocation Requirement: Candidate MUST be in Cincinnati, OH, and be available to work in the downtown office on a hybrid schedule (on-site Mon, Tues, Weds, remote Thurs & Fri.)We are seeking a detail-oriented Data Analyst for a 6-month W-2 contract-to-hire position. You will play a critical role in maintaining and developing business reporting functions,...
-
Data Analyst
3 weeks ago
Cincinnati, United States Fusiion Tech Full time $50 - $75Job DescriptionJob DescriptionThe ideal candidate will use their passion for big data and analytics to provide insights to the business covering a range of topics. They will be responsible for conducting both recurring and ad hoc analysis for business users. Key Responsibilities:Design, develop, and maintain data pipelines using Azure Data Factory.Extract,...
-
Program Analyst
2 months ago
Cincinnati, Ohio, United States Alcohol And Tobacco Tax And Trade Bureau Full timeThis position is located at Alcohol and Tobacco Tax and Trade Bureau (TTB), Assistant Administrator - Permitting and Taxation - National Revenue Center.The following are the duties of this position at the GS-13. If you are selected at a lower grade level, you will have the opportunity to learn to perform all these duties and will receive training to help you...
-
Associate Medical Director
3 months ago
Cincinnati, United States CommuniCare Advantage Full timeAssociate Medical Director The CommuniCare Family of Companies currently owns/operates more than 85 Nursing and Rehabilitation Centers, Specialty Care Centers and Assisted Living Communities in 7 states. Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management of adult living...
Grievance/Appeals Analyst II_
2 months ago
**Title: Grievance/Appeals Analyst II** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations. The **Grievance/Appeals Analyst II** will be responsible for reviewing, analyzing and processing non-complex and some complex pre service and post service grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (i.e. member, provider, regulatory, and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. **How you will make an impact:** + Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review. + The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews, and completion of the respective written communication documents to convey the determination. + The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation. + The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments. + Obtaining cooperation from these other areas requires an awareness of their functions and necessitates the development and maintenance of relationships to include instilling an awareness of our customer expectations and responses. + Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information. + Identify opportunities for improvement and any provide support and assistance to G&A Analyst I associates as needed. **Minimum Requirements** + HS diploma or equivalent + Minimum of 1 year of Grievance & Appeals analyst experience + Minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background. **Preferred Qualifications** + Associates degree preferred. + Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology is strongly preferred For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
