Member Appeal - Worcester

Fallon Health Appeals and Grievance process is an essential function to FH's compliance with CMS regulations, CMS 5 Stars, NCQA standards and member expectations. · This position is divided equally between Member Appeals and Grievances Department and Provider Appeals Department w ...

This Intake Administrator position is responsible for administering the FH Appeals and Grievance process. · Administer FH Standard and Expedited Appeals Processes. · Triage and assign incoming appeals and grievances. · Gather relevant information from members regarding grievances ...

This member intake administrator position is responsible for administering the appeals and grievance process for Fallon Health's compliance with CMS regulations and member expectations. · ...

This Intake Administrator position is responsible for administering the Fallon Health Appeals and Grievance process. · ...

This Intake Administrator position is in the Appeal and Grievance Department. · ...

This Intake Administrator position is in the Appeal and Grievance Department and may require training in our Worcester office. · About Us Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. ...

Join our team as a Team Store Associate at Polar Park for the Worcester Red Sox. As a key member of our Merchandise Team, you will create an exceptional fan experience by greeting and assisting fans enthusiastically in the Team Store and throughout the ballpark. · Key Responsibil ...

The Service Coordinator will assist in processing authorization information to facilitate medical services for Fallon Health members. · Accepts authorization service requests and notifications for FCHP members. · ...

The Service Coordinator will communicate with contracted and non-contracted facilities/agencies/providers to collect pertinent prior authorization request data. · This includes receiving incoming faxed/mailed/emailed requests and initiating entry of service request shells into co ...

Responsible for resolving outstanding no-response and post-appealed accounts receivables in the circumstance that balances have not been adjudicated and performing all related tasks. ...

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. · Responsible for resolving outstanding no-response and post-appealed accounts receivables in the circumstance that balances have not been adju ...

At UMass Memorial Health everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts and a place where we can help you build ...

WCS Healthcare Partners is seeking a local contract nurse RN ICU - Intensive Care Unit for a local contract nursing job in Worcester, Massachusetts. · Night Shift. · ...

The job is responsible for resolving outstanding no-response and post-appealed accounts receivables in the circumstance that balances have not been adjudicated. · Responsible for performing follow up on accounts that have not been initially adjudicated by the payer utilizing ass ...

At UMass Memorial Health everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts and a place where we can help you build ...

Responsible for follow-up of complex surgical/procedural/multidisciplinary specialty claims for payments including coding and analyzing claims and claim payments/rejections. · High School Diploma · ...

+We are seeking a Denial Resolution Specialist to join our team at UMass Memorial Health. As a key member of our revenue cycle team, you will be responsible for reviewing and analyzing denials to ensure prompt payment from payers. · +Review and analyze denial reasons for each ass ...

This position may have a signing bonus available to eligible candidates. At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. · ...

The Worcester Red Sox are seeking enthusiastic and motivated individuals to join the Merchandise Team for the 2026 baseball season as a Team Store Associate. · Provide a welcoming and positive shopping experience by greeting and assisting fans enthusiastically in the Team Store a ...

This role translates standard and complex business needs into Fallon Health configuration rules. · The benefit & provider configuration team is responsible for ensuring that claims payment and benefits are correctly configured in context of medical policies, reimbursement policie ...