Healthcare Appeals Specialist

Job Summary:Capital Rx is seeking a skilled Pharmacy Appeals Specialist to join our team. As a Pharmacy Appeals Specialist, you will be responsible for reviewing and processing appeals for pharmacy services, ensuring compliance with regulatory requirements and company policies.Key Responsibilities:Review and process appeals for pharmacy services, ensuring...

Job Title: Senior Administrative Appeals SpecialistLocation: NY Pittsford (NSA)Job Summary: Integrated Resources is seeking a detail-oriented and knowledgeable Senior Administrative Appeals Specialist to join our team. As a key member of our team, you will be responsible for maintaining updated knowledge of project and corporate policies and procedures. Your...

Job SummaryWe are seeking a highly skilled Pharmacy Technician, Appeals Specialist to join our team at Capital Rx. As a Pharmacy Technician, Appeals Specialist, you will play a critical role in ensuring the efficient and effective processing of appeals and prior authorizations for our clients.Key ResponsibilitiesReview and process appeals and prior...

Job Summary:We are seeking a highly skilled Pharmacy Technician to join our Appeals team. As a Pharmacy Technician, Appeals Specialist, you will be responsible for reviewing and processing appeals for our clients. This is a critical role that requires strong attention to detail, excellent communication skills, and the ability to work independently in a...

Position OverviewWe are seeking a detail-oriented and knowledgeable individual to fill the role of Federal No Surprise Act Coordinator-Appeals at Integrated Resources.Key ResponsibilitiesMaintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position.Function as a...

Job Title: Medicare Claims Appeals SpecialistJob Summary:The Medicare Claims Appeals Specialist is responsible for reviewing and resolving member and provider complaints, and communicating resolutions to members and providers in accordance with standards and requirements established by the Centers for Medicare and Medicaid Services (CMS).Key...

Job SummaryWe are seeking a highly skilled Grievance and Appeals Specialist to join our team at EmblemHealth. As a key member of our organization, you will be responsible for responding to written and verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with regulatory requirements.Key...

Job Title: RN Appeals NurseAt VillageCare, we are seeking a highly motivated and detail-oriented RN Appeals Nurse to join our team. As a key member of our Utilization Management team, you will play a critical role in conducting comprehensive analytic reviews of clinical documentation to support authorization decisions and appeal determinations.Key...

Job SummaryWe are seeking a highly skilled Pharmacist to join our team as a Prior Authorization and Appeals Specialist. In this role, you will be responsible for reviewing clinical coverage determinations and appeals for various lines of business, including Commercial and Medicare. You will work closely with internal and external Medical Directors to provide...

OverviewWe are seeking a detail-oriented and knowledgeable individual to join Integrated Resources as a Federal No Surprise Act Coordinator-Appeals. This role will involve functioning as a Subject Matter Expert in one or more process areas, analyzing data submitted for Independent Medical Review, and collecting and analyzing incoming data and reports from...

About the RoleWe are seeking a highly skilled Grievance & Appeals Specialist to join our team at EmblemHealth. As a key member of our organization, you will be responsible for responding to written and verbal grievances, complaints, and appeals submitted by members and providers in accordance with NCQA, CMS, State, and other regulations.Key...

About the RoleWe are seeking a skilled Appeals and Grievances Specialist I to join our team at Solugenix Corporation. This is a 6-month contract opportunity based out of Los Angeles, CA (Remote).Key ResponsibilitiesMaintain the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting...

About the Role:The Appeals and Grievances Specialist I will be responsible for maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to company policy and procedures, including accreditation requirements, and applicable federal, state and...

About the RoleWe are seeking a highly skilled and detail-oriented Grievances and Appeals Representative to join our team at Humana. As a key member of our healthcare services team, you will play a critical role in ensuring that our members receive the best possible care and support.Key ResponsibilitiesConduct comprehensive analytic reviews of clinical...

Position: We are seeking a detail-oriented and knowledgeable individual to fill the role of Sr. Admin Appeals at Integrated Resources.Key Responsibilities:Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position.Function as a Subject Matter Expert in one or...

Job Title: Federal No Surprise Act Coordinator-AppealsIntegrated Resources is seeking a detail-oriented and knowledgeable individual to fill the role of Federal No Surprise Act Coordinator-Appeals. This position requires a strong understanding of healthcare law, arbitration, mediation, dispute resolution, and claims adjudication in healthcare.Key...

Job OverviewVillageCare MAX seeks a highly skilled Supervisor of Grievances and Appeals to oversee the investigation and resolution of complaints and grievances from members.This role is responsible for managing all aspects of the grievance system, ensuring compliance with DOH and CMS requirements, and working to investigate and process grievances in a...

Job Summary:Capital Rx is seeking a skilled Clinical Pharmacist to join our team in reviewing clinical coverage determinations and appeals for various lines of business, including Commercial and Medicare. As a Clinical Pharmacist, you will be responsible for evaluating and reviewing appeals requests, rendering coverage determinations based on clinical...

Job SummaryAscension Via Christi is seeking a skilled RN to join our team as a Healthcare Specialist. In this role, you will provide health care services regarding admissions, case management, discharge planning, and utilization review. Your expertise will be utilized to review admissions and service requests within assigned units for prospective,...

As a valued member of the care delivery team at Stormont-Vail HealthCare, you will function under the direction of, and be assistive to, a Registered Nurse to provide delegated, direct patient care intervention, including the performance of sterile and non-sterile procedures.Key Responsibilities:Assist in the delivery of patient care services, working...