Jobs near Indianapolis: 6,462
RS
Relevance Score ranked on: APPEALS
Manager I – Grievances & Appeals – Provider Disputes
INDIANAPOLIS, 220 VIRGINIA AVE
Serves as a functional resource expert and mentor to unit and other departments for complex issues and interpretation of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non-cli...
Search Terms: Manager, Appeals, Dispute, Healthcare, Benefits
87.8
0mi
Updated: September 14
Grievance/Appeals Analyst I
INDIANAPOLIS, 220 VIRGINIA AVE
?Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language. Utilizes guidelines and review tools to conduct ex...
Search Terms: Appeals, Analyst, Administrative, Healthcare, Medical
87
0mi
Updated: September 14
Medical Director-Appeals (Primary Care-IM or FM)
INDIANAPOLIS, 220 VIRGINIA AVE
Appeal Reviews. Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determ...
Search Terms: Medical Director, Director, Appeals, Medical, Behavioral Health
86.3
0mi
Updated: September 18
Medical Director-Appeals (Primary Care-IM or FM)
INDIANAPOLIS, 220 VIRGINIA AVE
Appeal Reviews. Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determ...
Search Terms: Medical Director, Director, Appeals, Medical, Behavioral Health
85.2
0mi
Updated: September 14
Manager II Grievance/Appeals (RN)
INDIANAPOLIS, 220 VIRGINIA AVE
Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance. - Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines. - Addresses both internal/external cu...
Search Terms: Manager, Appeals, Administrative, Healthcare, Benefits
84.9
0mi
Updated: September 12
Population Health Management Pharmacist – CarelonRx
INDIANAPOLIS, 220 VIRGINIA AVE
Researches and synthesizes detailed clinical data related to pharmaceuticals to assist contracted providers in achieving cost and quality goals. Serves as a clinical resource to other pharmacists and contracted providers in areas such as prospective, inpatient, and retrospective DU - Rs and clinical ...
Search Terms: Pharmacist, Health, Management, Pharmacy, Healthcare
0
0mi
Updated: September 20
Investigator II - Carelon Payment Integrity SIU
INDIANAPOLIS, 220 VIRGINIA AVE
Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claims systems for review of facility, professional, and pharmacy claims. Responsible for identifying and developing enterprise-wide specific healthcare investigations that may ...
Search Terms: Investigator, Payment, Integrity, Healthcare, Business Services
0
0mi
Updated: September 20
Commercial Formulary Pharmacist - CarelonRx
INDIANAPOLIS, 220 VIRGINIA AVE
Leads Commercial formulary management processes. Responsible for all member, stakeholder, and provider communications regarding formulary changes. Ensures appropriate formulary set-up and claims adjudication. Serves as a clinical pharmacy resource to pharmacy benefit management and pharmacy operation...
Search Terms: Pharmacist, Commercial, Pharmacy, Healthcare, Compensation
0
0mi
Updated: September 20
Health Insurance Exchange Pharmacist - CarelonRx
INDIANAPOLIS, 220 VIRGINIA AVE
Lead Health Insurance Exchange formulary management processes. Responsible for all member, stakeholder, and provider communications regarding formulary changes. Ensure appropriate formulary set-up and claims adjudication. Serve as a clinical pharmacy resource to pharmacy benefit management and pharma...
Search Terms: Health, Pharmacist, Insurance, Healthcare, Pharmacy
0
0mi
Updated: September 20
Investigator Senior
INDIANAPOLIS, 220 VIRGINIA AVE
Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims. Responsible for independently identifying and developing enterprise-wide specific healthcare investigatio...
Search Terms: Investigator, Senior, Healthcare, Technology, Insurance
0
0mi
Updated: September 20
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