of all prior authorization determinations. Provides resolution to grievances and appeals issues. Responds to inquiries... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work...
. Investigate, prepare documentation, and recommend Tessera’s position on grievances, complaints, and appeals. Responds to employee.... Maintain working relationship with union officials and adheres to terms of labor contract by supporting Manager in the day...
and participates in appeal or fair hearings, member grievances, appeals, and state audits. Minimum Requirements: Requires BA/BS... virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week...
grievances, appeals, and state audits. Minimum Requirements: Requires BA/BS degree and a minimum of 2 years of experience... virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week...
to supervisors, manager, directors, and Executives ensuring proper interpretation and administration of contract provisions relating... to employee grievances or issues. Assisting in the administration of the Department's discipline program, including suspending...
and participates in appeal or fair hearings, member grievances, appeals, and state audits. Minimum Requirements: Requires BA/BS... Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates...
existing or potential labor relations issues. Assisting in providing advice and consultation to supervisors, manager... grievances or issues. Assisting in the administration of the Department's discipline program, including suspending employees...
Experience in Appeals & Grievances review in clinical services for one or more of the following lines of business: Medicare... Training Consultant, Training Manager, and other Trainers Maintain Industry Knowledge: Maintain knowledge of current...
and escalates grievances to supervisor. Maintains new and existing patient profiles and enters new prescriptions into patient... with required prior authorization and required appeals. Manage all mail/delivery of Rx orders including addressing problems/issues...
including Digital, Marketing, Claims, Appeals, Grievances, Disputes and Line of Business. The Medical Informatics Analyst... - Consultant (Medical Specialty Integration) will report to the Senior Manager of Medical Informatics and play a critical role...
Case Manager Supervisor Reports to Director of Supportive Services SUMMARY OF PRIMARY FUNCTION The Case Manager... concerns, and any other pertinent matters. Follows agency policy in handling participant and staff grievances, complaints...
is responsible for driving results for customer including A/R follow up, RAP and NOE submission, reporting, appeals, day-to-day... Manager or Client Success Manager. Communication with an agency regarding status of AR should be done by setting up calls...
review, medical coding (CPT, ICD-9) or appeals and grievances. Experience in DRG auditing preferred. Coding certification... as applicable. Upholds HIPAA privacy and security guidelines. Appeals administration and oversight Conduct audit of appeals...
. This position falls within our Community & State Appeals and Grievances Department. You will consult with staff, including... contracts requirements. Accordingly, to investigate, file creation, attending staffing for member grievances and appeals...
. This position falls within our Community & State Appeals and Grievances Department. You will consult with staff, including... contracts requirements. Accordingly, to investigate, file creation, attending staffing for member grievances and appeals...
with Medicare Part D. Three years’ experience in CDAG (coverage determinations, appeals, and grievances) Preferred: Previous..., guidelines, and CMS requirements 2. Researches and responds to Part D grievances and inquiries, conducting outreach...
operations. Ensure that the Grievances and Appeals Procedure, "Equal Housing Opportunity", "Justice for ALL", and labor posters... Community Manager with coordinating business operations of HUD/RD or Tax Credit properties, providing eligible individuals...
organization and oversees Analytics relating to Contact Center, Digital, Marketing, Claims, Appeals, Grievances, Disputes, Customer... Experience and Lines of Business. The Data Analyst, Senior will report to the Senior Manager of Inventory Management...
education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management... with providers, payers or 3rd parties for: Claims adjustments Grievances and appeals submissions Utilization management intake...
; ensure the availability and quality of student advising and mentoring based on best practices; manage grade and other appeals... and grievances with others as appropriate in the school. Lead outstanding departmental educational programs and curricula overall...