Medical Grievance Analyst

OverviewPurpose: To lead the appeals and grievances team in delivering exceptional customer service, ensuring compliance with regulatory requirements and promoting a positive work environment.Responsibilities:• Manage day-to-day operations of the appeals and grievances department, overseeing staff performance and adherence to company policies.• Foster a...

About UsPoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized healthcare experience to everyone in our communities. As a key member of our team, you will be part of a collaborative and dynamic environment that fosters innovation, growth, and development.Job SummaryThis is an exceptional opportunity to join our...

About UsAt Point32Health, we strive to provide high-quality and affordable healthcare services, improving the health and wellness of our members and creating healthier communities across the country.Job SummaryThis is a challenging opportunity for an experienced Healthcare Business Analyst to join our team. As a key member of our business analysis team, you...

About the RoleAs a seasoned professional, you will oversee the complex day-to-day operations of our Appeals and Grievances Department. This is an excellent opportunity to utilize your leadership skills and drive operational efficiency while ensuring compliance with evolving industry standards and regulations.Responsibilities• Provide guidance and support...

Job SummaryThe Healthcare Administrative Coordinator - Appeals and Grievances will play a crucial role in supporting the Appeals and Grievances department at Point32Health. This position is responsible for assisting with all operational aspects of the appeals and grievances assignment process, ensuring compliance with state and federal regulations.Key...

Job SummaryUnder the general direction of the Director, Appeals & Grievances, this role is responsible for overseeing the overall management of member appeals and grievance processes across responsible lines of business. The successful candidate will ensure compliance with regulatory requirements, facilitate internal and external contributions to case...

Position: Medical Assistant Job Description: Schedule, confirm patient appointments, check-ups, and physician referrals Answer telephones and direct calls to appropriate staff Greet visitors, assess purpose of visit, and direct them to appropriate staff Compile record medical charts, reports, and correspondence. Some experience with electronic medical record...

Job SummaryUnder the oversight of the Senior Manager of Consulting and Operations, this individual will support the operations and analysis of risk adjustment strategy across Point32Health business lines. The Data Analyst will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing...

Who We Are Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and...

Job SummaryThe Data Analyst - Actuarial Science role supports the analysis and data needs for a broad range of financial and actuarial functions. This support will include rate reviews, financial planning and projections, trend analysis, product development, provider reimbursement analysis, fee schedule development, provider risk analysis, and medical cost...

Job SummaryNTT DATA is seeking a highly skilled Senior Business Systems Analyst to join our team. As a key member of our organization, you will be responsible for defining and analyzing business problems and aligning technical solutions. Your exceptional analytical and problem-solving skills will enable you to identify and evaluate existing and potential IT...

Job SummaryThe Senior Financial Analyst - Data Insights will support the analysis and data needs for a broad range of financial and actuarial functions. This support will include rate reviews, financial planning and projections, trend analysis, product development, provider reimbursement analysis, fee schedule development, provider risk analysis, and medical...

Job DescriptionJob DescriptionMinimum 1+ years Behavior Specialist experience required.Board Certified Behavior Analyst ProCare Therapy is actively searching for a highly skilled Board Certificate Behavior Analyst (BCBA) in Canton, MA that is seeking to join one of our trusted school districts for the 2024-2025school year. At ProCare Therapy our mission is...

Job DescriptionJOB FUNCTION/PURPOSE:The Business Analyst will work under the direction of the Business Systems Management Officer and will help to gather, analyze, and present data for departmental needs and management decisions pertaining to retail loan operations. In addition, the position will play a major contributing role in the oversight of process...

Michigan Milk Producers Association (MMPA) is actively interviewing for a Business Systems Analyst to join our Information Technology Department in our Novi, MI Headquarters. The primary focus for this role will be to document process, provide technical support, and train users on the use of MMPA's business systems (Primarily Microsoft Dynamics 365 Finance &...

*Board Certified Behavioral Analyst (BCBA)*For a complete understanding of this opportunity, and what will be required to be a successful applicant, read on.*Part-time and Full-time opportunities in Canton, MA** _*Part-time pay: *_$65 - $75 an hour _($1,000 signing bonus)_* _*Full-time hours:*_ 25 billable and 5 non-billable _($2,000 signing bonus)_*What...

Job DescriptionJob DescriptionJob SummaryWorking under the direction of the Director or Senior Manager, the Senior Analyst will be part of a team responsible for the development, negotiation, monitoring and reporting of the contractual agreements with health care providers and institutions. Responsibilities include supporting provider negotiations,...

Job SummaryThe Actuarial Analyst I support the analysis and data needs for a broad range of financial and actuarial functions. This support will include rate reviews, financial planning and projections, trend analysis, product development, provider reimbursement analysis, fee schedule development, provider risk analysis, and medical cost containment...

FlexCare Medical Staffing is seeking an experienced Pre-Op Registered Nurse for an exciting Travel Nursing job in Canton, GA. Shift: 4x10 hr days Start Date: 01/13/2025 Duration: 13 weeks Pay: $1706.54 / Week NOTE: THIS IS A TRAVEL STAFFING ASSIGNMENT. INQUIRE TODAY FOR JOB DETAILS. Licensing, certifications, and other requirements...

FlexCare Medical Staffing is seeking an experienced Telemetry Registered Nurse for an exciting Travel Nursing job in Canton, OH. Shift: 3x12 hr nights Start Date: 01/17/2025 Duration: 13 weeks Pay: $1375.04 / Week NOTE: THIS IS A TRAVEL STAFFING ASSIGNMENT. INQUIRE TODAY FOR JOB DETAILS. Licensing, certifications, and other requirements...

Who We Are Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and...

Job SummaryCritical care nurses with experience in LTACH and telemetry settings are highly sought after by our clients. As a critical care nurse on our team, you will have the opportunity to work in various healthcare facilities across the country, utilizing your skills to make a positive impact on patient outcomes.We are seeking experienced LTACH and...

Job OverviewAkoya Behavioral Health is a pioneering in-home ABA program dedicated to supporting children with autism. Our family-centric approach emphasizes collaboration between clients, families, and clinical staff.We are seeking an experienced Clinical Supervisor to lead our team of Board Certified Behavior Analysts (BCBAs) and Registered Behavior...

Job DescriptionJob DescriptionMinimum 1+ years Behavior Specialist experience required.Seeking a new opportunity within a school district? ProCare Therapy proudly collaborates with an outstanding school district in Canton, Massachusetts search of a dedicated Board Certified Behavioral Analyst to join their team for the ongoing school year!Board Certified...