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67 fresh jobs found

Lead Grievance & Appeals Coordinator
Remote-CA, United States

Centene Corporation

Grievance Management Appeals processing Grievance Ncqa standards NCQA Compliance monitoring Report Preparation Health Plan Appeals +21

Senior Mid Full Time

USD 44K+

Supervisor, Insurance Billing
US Remote

Billing platforms CMS regulations Submissions Denial Management Insurance Billing Dispute resolution Denials Cell-free DNA HL7 +40

Senior Full Time

USD 63K+

Remote Child / Adolescent Medical Director - Florida
Remote-FL, United States

Centene Corporation

Utilization Claims review Clinical quality improvement Medical management programs Health care quality Provider network development Health financing Personnel management Accreditation Standards +39

Exec Senior Full Time

USD 231K+

Field Reimbursement Specialist - San Francisco, CA
US - California - Thousand Oaks - Field/Remote, United States

Collaborative territory strategic plan Insurance forms Budgets Formulary coverage Reimbursement process Financial assistance programs Payer prior authorization Patient health information Benefits investigation +53

USD 155K+

Appeals Specialist II
Remote-TX, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Mid Full Time

USD 40K+

Complaints and Issues Specialist II
Remote-MO, United States

Centene Corporation

Complaint Resolution Medicare Knowledge Grievances Customer Care Contact center Appeals Quality Standards Procedures Claims +21

Entry Mid Full Time

USD 55K+

Medical Director - Gulf South
Remote US, United States

Post-acute services Grievance and appeals processes Community Groups Outpatient services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +88

Exec Senior Full Time

USD 223K+

Remote PRN Medical Director - Missouri
Remote-MO, United States

Centene Corporation

Clinical quality improvement Pediatrics Health financing Clinical programs Personnel management Clinical Quality Medical Review Health administration Medical Services +24

Exec Mid Part Time

USD 212K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Community Groups Outpatient services Grievance and appeals processes Inpatient rehabilitation Commercial health insurance Clinical group practice management Post-acute care Humana policies +83

Exec Senior Full Time

USD 223K+

Grievance & Appeals Coordinator I
Burr Ridge - 1333 Burr Ridge Pkwy, Ste 125 (10938), United States

Centene Corporation

Claims research Utilization Grievance Grievances Managed care experience HEDIS Appeals Medical management Health Services +14

Entry Mid Full Time

USD 64K+

Manager, Denials and Appeals
US Remote

Payer compliance regulations Appeals processes Payer contract analysis Coding regulations Denials management PHI Reimbursement methodologies Insurance Billing Insurance Verification +42

USD 95K+

Quality Control Reviewer
REMOTE OPTIONS, PHOENIX

State of Arizona

Eligibility programs Mathematical computation Eligibility Determination Automated Systems Federal Laws Federal and state laws Policies and procedures State laws Report development +38

USD 46K+

Veterans Benefits Counselor
REMOTE OPTIONS, FLAGSTAFF

State of Arizona

Electronic record management Veterans benefits Communications planning Client counseling AMS Policies and procedures State laws Performance measures Interviews +39

USD 42K+

Product Operations Specialist
Remote-IL, United States

Centene Corporation

Grievances Operational performance Contact center Appeals Reporting tools Regulatory Affairs Claims Pharmacy Root Cause Analysis +33

USD 55K+

Medical Director - Pacific SW
Remote US, United States

Health claims review Community Groups Outpatient services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +84

Exec Senior Full Time

USD 223K+

Remote Beahvioral Medical Director - Kentucky
Remote-KY, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Health care quality Medical management programs Health financing Provider network development Government programs Clinical Quality Medical Review +39

Exec Mid Full Time

USD 231K+

Medical Director- South Central
Remote US, United States

Community Groups Outpatient services Grievance and appeals processes Post-acute services Clinical group practice management Inpatient rehabilitation Post-acute care Commercial health insurance Humana policies +86

Exec Senior Full Time

USD 223K+

Accounts Receivables Specialist 2
Remote - IA, United States

Star Dde medicare claim system Paragon Pbar All scripts Medical collections CPSI Billing guidelines Health information systems +17

USD 48K+

Field Reimbursement Manager, Pulmonology and Gastroenterology - Denver, CO
Remote, US, United States

Access Issue Resolution Financial assistance Patient Support Services Gastroenterology Rare diseases Appeals Patient Support Biologics Prior authorization +25

USD 122K+

Associate Well-Being Experience Lead
Remote US, United States

Innovative mindset Behavioral economics Clinical programs Health promotion Psychology Appeals Health outcomes Population health Efficiency +42

USD 94K+

Case Manager, Patient Services
Remote (United States), United States

PTC Therapeutics, Inc.

Peer-to-peer review Administrative functions Pharmacy Billing Healthcare insurance Patient Engagement Appeals Patient services Prior authorization Active Listening +11

USD 81K+

Grievance & Appeals Coordinator II
Remote-PA, United States

Centene Corporation

Grievance Grievance resolution Grievances Claims analysis Medical Review Appeals Medical management Health Services Procedures +17

USD 44K+

Medical Director - Northeast Region
Remote US, United States

Community Groups Outpatient services Post-acute services Grievance and appeals processes Clinical group practice management Commercial health insurance Post-acute care Inpatient rehabilitation CMS policies +88

Exec Senior Full Time

USD 223K+

Appeals Specialist II
Remote-NY, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Full Time

USD 40K+

Field Reimbursement Manager - Rare Blood Disorders, Patient Support Services
Remote, US, United States

Access Issue Resolution Financial assistance Patient Support Services Patient Support Programs Payer Environment Product Access Regulatory Guidelines Rare diseases Appeals +32

USD 122K+

Remote Medical Director (PRN) - California
Remote-CA, United States

Centene Corporation

Clinical quality improvement Clinical programs Health financing Medical Review Clinical Quality Personnel management Health Plan Health administration Medical Services +24

Exec Mid Part Time

USD 222K+

Project Manager II (Grievance and Appeals)
Remote-CA, United States

Centene Corporation

Grievance Project documentation Project Management Software MS Project Project management tools Appeals PMP Requirements Gathering Healthcare experience +20

USD 68K+

Clinical Review Clinician - Appeals (RN)
Remote-TX, United States

Centene Corporation

Appeals process Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity Medical Records +23

USD 95K+

Claims Analyst II
Remote-CA, United States

Centene Corporation

ABS Amisys Revenue Codes ICD-9 Marketplace HCPCS Training Programs Appeals ICD-10 +20

Entry Mid Full Time

USD 38K+

Supervisor, Clinical Grievance and Appeals
Remote-MO, United States

Centene Corporation

Grievance Ncqa standards Grievances NCQA Quality Metrics Medical necessity Clinical operations Appeals Medical management +28

USD 68K+

Medical Director - Kansas
Remote-KS, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Medical Review Accreditation Standards +38

Exec Senior Full Time

USD 221K+

Supervisor, Appeals Grievance
Remote-MO, United States

Centene Corporation

Appeals Management Grievance resolution Grievances Health Plan Report Preparation Performance Evaluation Trend Analysis Appeals Medical management +23

USD 55K+

Manager, Quality Improvement
Remote-FL, United States

Centene Corporation

Budget Preparation Accreditation Appeals Clinical Experience Quality improvement Procedures Supervisory Quality Management Nursing +16

USD 86K+

Medical Management Auditor
Remote-WI, United States

Centene Corporation

CCMS Clinical Systems InterQual System Maintenance Corrective Actions Health Plan Credentialing Appeals Medical management +16

USD 55K+

Senior Reimbursement and Market Access Specialist (REMOTE)
Michigan, Virtual Address, United States

Medical procedures Payer methodologies Denials M Coverage HCPCS Appeals ICD-10 Prior authorization +21

Senior Full Time

USD 69K+

Manager, Prior Authorizations
Austin, TX · US Remote

Accounts receivable management Healthcare research Denials management Pre-certification PHI Insurance Billing Healthcare policy Research and Analysis Insurance Verification +43

USD 95K+

Manager, Grievances & Appeals
Remote US, United States

Tactical Operations Bilingual English and Spanish Grievance and appeals Grievances Healthcare Delivery Medicare Advantage Health and wellness Workforce management Productivity +65

USD 86K+

Remote Medical Director - Texas
Remote-TX, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Health administration Accreditation Standards +37

Exec Senior Full Time

USD 231K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Health administration Accreditation Standards +37

Exec Senior Full Time

USD 231K+

Eligibility and Prior Authorization Specialist-Temp to hire
Remote

Payer Portals Modifiers Payer utilization management UB revenue codes Medical billing systems Insurance collections Billing Systems Cell-free DNA Medical Billing +35

USD 46K+

Medical Director, Behavioral Health Services - Washington
Remote-WA, United States

Centene Corporation

Medical care standards Behavioral health management Authorization evaluation Grievance resolution Behavioral health services Authorization requests Claims review Grievances Evidence-based practice +29

Exec Senior Full Time

USD 210K+

Manager, Grievance & Appeals
Remote-IN, United States

Centene Corporation

Grievances Appeals Medical management Health Services Procedures Supervisory Regulatory Health Insurance Clinical +9

USD 68K+

Remote Behavioral Medical Director - western region
Remote-CA, United States

Centene Corporation

Clinical practice improvement Clinical quality improvement Medical management programs Provider network development Health care quality Health financing Personnel management Health administration Accreditation Standards +36

Exec Senior Full Time

USD 231K+

Remote Behavioral Medical Director – West Region
Remote-CA, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Medical management programs Provider network development Health care quality Health financing Personnel management Health administration Medical Review +36

Exec Senior Full Time

USD 231K+

Field Reimbursement Specialist
USA - MA - Remote, United States

AmerisourceBergen

Specialty distribution Buy and bill Coverage management Educational presentations Pharmacy benefits Reimbursement support Patient assistance Health policy Liaison +25

USD 86K+

Remote Child & Adolescent Behavioral Medical Director - Washington
Remote-WA, United States

Centene Corporation

Adverse trend evaluation Clinical quality improvement Medical Necessity Review Provider network development Medical management programs Health care quality Health financing Clinical collaboration Personnel management +36

Exec Mid Full Time

USD 231K+

Field Reimbursement Specialist - Chicago, IL
US - Illinois - Chicago - Field/Remote, United States

Insurance forms Financial assistance programs Collaborative territory strategic plan Formulary coverage Reimbursement process Payer prior authorization Patient health information Benefits investigation Reimbursement issue resolution +50

USD 155K+

Field Reimbursement Specialist - Florida South
US - Florida - Jacksonville - Field/Remote, United States

Patient health information Financial assistance programs Benefits investigation Formulary coverage Payer prior authorization Reimbursement process Reimbursement issue resolution Patient Support Programs Claims resolution +47

USD 155K+

Field Reimbursement Specialist - Los Angeles, CA
US - California - Thousand Oaks - Field/Remote, United States

Patient health information Benefits investigation Financial assistance programs Payer prior authorization Reimbursement process Formulary coverage Reimbursement issue resolution Claims resolution Healthcare provider education +49

USD 155K+

Field Reimbursement Specialist - Minneapolis, MN
US - Minnesota - Minneapolis -Field/Remote, United States

Formulary coverage Payer prior authorization Financial assistance programs Benefits investigation Patient health information Reimbursement process Reimbursement issue resolution Claims resolution Denials +44

USD 155K+

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