Appeals and Grievances Coordinator
2 weeks ago
We are seeking a highly organized and detail-oriented Appeals and Grievances Coordinator to join our team at The Health Plan of West Virginia, Inc. The successful candidate will be responsible for handling appeals and grievances in accordance with regulatory guidelines and company policies.
Key Responsibilities- Handle assigned appeals and grievances by inputting data into databases, writing acknowledgment letters, and obtaining medical records as needed.
- Research cases, resolve issues, and submit resolution letters while ensuring regulatory time frames are met.
- Respond timely to inquiries from authorized representatives, providers, and internal staff regarding appeals and grievances.
- Work closely with other departments to research and resolve member/provider appeals and grievances.
- Contact providers and external agencies to obtain additional supporting documentation.
- Investigate and resolve priority appeals and concerns in a timely and efficient manner.
- Adhere to all policies and procedures and ensure regulatory guidelines are followed.
- Accurately log, track, and process appeals and grievances into the OICS platform.
- Maintain concise documentation associated with the processing and handling of appeals and grievances.
- Presents ideas for performance and process improvement changes to supervisor.
- Notify supervisor of identified appeal and grievance patterns, claim errors, or systemic problems.
- Prepare case files for the Appeal Committee.
- Notify members/providers of the outcome of their appeal and next step process.
- High school diploma; college preferred.
- Detail-oriented with excellent customer service skills.
- Ability to work independently and as part of a team.
- Excellent time management skills with the ability to meet regulatory guidelines.
- Proficient in Microsoft Office products.
- Ability to review, understand, and apply policy provisions.
- Knowledge of managed care, state, and federal guidelines and regulations.
- Previous experience in managed care settings.
- Familiarity with medical terminology, ICD 10, and CPT coding.
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Appeals and Grievances Coordinator
2 weeks ago
Arlington Heights, Illinois, United States The Health Plan of West Virginia, Inc. Full timeJob Title: Appeals and Grievances CoordinatorAt The Health Plan of West Virginia, Inc., we are seeking a highly organized and detail-oriented Appeals and Grievances Coordinator to join our team. As a key member of our operations team, you will be responsible for handling appeals and grievances in accordance with regulatory standards and requirements.Key...
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Hospice Volunteer Program Coordinator
2 weeks ago
Arlington Heights, Illinois, United States Residential Home Health and Hospice Full timeJoin Our Team as a Hospice Volunteer CoordinatorAt Residential Home Health and Hospice, we're committed to delivering exceptional care to our patients. As a Hospice Volunteer Coordinator, you'll play a vital role in supporting our team and providing compassionate care to those in need.Key Responsibilities:Develop and implement the Hospice Volunteer program,...
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Hospice Volunteer Program Coordinator
2 weeks ago
Arlington Heights, Illinois, United States Residential Home Health and Hospice Full timeAt Residential Home Health and Hospice, we're seeking a compassionate Volunteer Coordinator to join our extraordinary care team. As a key partner with our field staff and leaders, you'll provide exceptional support to our patients and families. With our 20-year track record of delivering outstanding care, we're a strong leader in the industry and...
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Imaging Services Coordinator
1 month ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryWe are seeking a highly skilled and experienced Resource Coordinator for Imaging Services to join our team at Northwestern Medicine. This full-time position will be responsible for coordinating patient flow through the department, resolving scheduling issues, and maintaining administrative user access to diagnostic imaging systems.Key...
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Imaging Services Coordinator
1 month ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryThe Resource Coordinator Imaging Services reflects the mission, vision, and values of Northwestern Memorial Healthcare, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.Key ResponsibilitiesProvides...
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Seafood Order Coordinator
3 weeks ago
Arlington Heights, Illinois, United States Whole Foods Market Full timeJob SummaryWe are seeking a highly skilled and detail-oriented Seafood Order Writer to join our team at Whole Foods Market. As a key member of our seafood department, you will be responsible for ensuring the accurate and timely ordering of seafood products, maintaining inventory levels, and providing exceptional customer service.Key ResponsibilitiesReplenish...
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Volunteer and Governance Specialist
2 weeks ago
Arlington Heights, Illinois, United States NATIONAL ASSOCIATION OF THE REMODEL Full timeAbout the RoleThis is a unique opportunity to join the National Association of the Remodeling Industry as a Volunteer and Governance Specialist. In this role, you will support the organization's governance-related schedules and functions, develop strategies to recruit and retain volunteers, and provide guidance and support to internal leadership and related...
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Arlington Heights, Illinois, United States Gpac Full time**Workers' Compensation Legal Assistant Opportunity**We are seeking a highly skilled and experienced Workers' Compensation Legal Assistant to join our team at GPAC. As a key member of our team, you will provide exceptional support to our attorneys in preparing and filing workers' compensation documents, conducting legal research, and communicating with...
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Service Coordinator
3 weeks ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full timeJob Title: Wraparound Service CoordinatorAt Hoyleton Youth and Family Services, we are seeking a highly skilled and compassionate Wraparound Service Coordinator to join our team. As a key member of our staff, you will play a vital role in providing support to youth and families who have been referred to our Wraparound Program.Job SummaryThe Wraparound...
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Care Coordinator Manager
1 month ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full timeJob OpportunityWe are seeking a dedicated and compassionate individual to fill the role of Care Coordinator Manager at Hoyleton Youth and Family Services.This position offers a competitive salary and a comprehensive benefits package, including health, dental, and vision insurance, a health savings account, life insurance, and a 403(b) retirement plan with up...
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Wraparound Service Coordinator
2 weeks ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full time{"title": "Wraparound Service Coordinator", "description": "Job SummaryWe are seeking a highly skilled and compassionate Wraparound Service Coordinator to join our team at Hoyleton Youth and Family Services. As a key member of our multidisciplinary team, you will work collaboratively with youth, families, and professionals to design and deliver services that...
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Home Health Registered Nurse
2 weeks ago
Arlington Heights, Illinois, United States Residential Home Health and Hospice Full timeJoin Our Team of Compassionate Home Health Care ProfessionalsWe are seeking a highly skilled and compassionate Home Health Registered Nurse to join our team at Residential Home Health and Hospice. As a member of our care team, you will have the opportunity to make a meaningful difference in the lives of our patients and their families.About the Role:Provide...
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Service Coordinator
1 week ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full timeJob SummaryThe Wraparound Service Coordinator plays a vital role in collaborating with youth, family, guardian, caseworker, and DCFS to design and deliver services that meet the youth's needs.Key ResponsibilitiesComplete a strength-based Discovery Assessment with the child and family and the Child and Adolescent Needs and Strength Assessment (CANS) at the...
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Home Health Registered Nurse
3 weeks ago
Arlington Heights, Illinois, United States Residential Home Health and Hospice Full timeJoin Our Team of Dedicated Home Health ProfessionalsAt Residential Home Health and Hospice, we're committed to delivering exceptional care to our patients in the comfort of their own homes. As a Home Health Registered Nurse, you'll play a vital role in our team-based environment, working closely with our experienced care team to provide personalized care...
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Wraparound Service Coordinator
2 weeks ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full timeJob SummaryThe Wraparound Service Coordinator plays a critical role in supporting youth and families through the Wraparound Program. This position requires strong organizational and communication skills, as well as the ability to work effectively with diverse stakeholders.Key ResponsibilitiesEvaluate and interpret referral information to develop effective...
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Intensive Care Coordinator
2 weeks ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full timeJob SummaryThe Intensive Care Coordinator is a critical role within the Care Coordination and Support program, responsible for providing care coordination to youth who require the coordination of community services. This position is part of the Pathways to Success program, which aims to provide support to youth and families who have been referred to the...
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Wraparound Service Coordinator
1 month ago
Fairview Heights, Illinois, United States Hoyleton Youth and Family Services Full timeJob SummaryWe are seeking a highly skilled and compassionate Wraparound Service Coordinator to join our team at Hoyleton Youth and Family Services. As a key member of our multidisciplinary team, you will work collaboratively with youth, families, and professionals to design and deliver services that meet the unique needs of each child and family.Key...
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Front Desk Receptionist
2 weeks ago
Arlington Heights, Illinois, United States Comfort inn and Suites Arlington Heights Full timeJob SummaryAs a Front Desk Receptionist at Comfort Inn & Suites Arlington Heights, you will be the first point of contact for guests, ensuring a positive experience from check-in to check-out. This role requires a friendly, professional demeanor, strong communication skills, and the ability to handle a variety of tasks efficiently.Key Responsibilities:Greet...
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RN Charge Auditor
2 weeks ago
Glendale Heights, Illinois, United States Ascension Full timeJob SummaryWe are seeking a skilled RN Charge Auditor to join our team at Ascension Wisconsin. As a key member of our revenue cycle team, you will be responsible for ensuring accurate charge capture and reimbursement for our patients.Key Responsibilities:Coordinate payer denials and appeals, responding to insurance company requests for medical records and...
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Chicago Heights, Illinois, United States Prairie State College Full timeJob SummaryWe are seeking a highly skilled and experienced Administrative Assistant to support the Student Affairs and Dean of Equity teams at Prairie State College. The successful candidate will provide administrative support to two College Administrators, performing a range of tasks including preparing and sending correspondence, maintaining records, and...