- Indianapolis, Indiana - $18.15
- East Syracuse, New York - $18.15
- Harrisburg, Pennsylvania - $17.25
- Denison, Texas - $17.25
- South Portland, ME - $17.25
- Reviews analyzes, and processes non-complex grievances and appeals by 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 extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
- The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements.
- As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
- Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completes the respective written communication documents to convey the determination.
- Responsibilities exclude conducting any utilization or medical management review activities that require the interpretation of clinical information.
- The analyst may serve as a liaison between grievances & and appeals and /or medical management, legal, and/or service operations, and other internal departments.
- Requires a High school diploma or GED; up to 2 years experience working in grievances and appeals, claims, or customer service or any combination of education and/or experience which would provide an equivalent background.
- Familiarity with medical coding and medical terminology demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, all of the company's internal business processes, and internal local technology strongly preferred.
-
SCA Appeals Representative I
2 weeks ago
Elevance Health Harrisburg, United StatesSCA Appeals Representative ILocations: PA-Harrisburg, IN-Indianapolis, ME-South Portland, TX-Denison, NY-East Syracuse. This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS Elevance Health Pulse Point locations listed on the requisition.Nati ...
-
SCA Appeals Representative I
2 weeks ago
Elevance Health Harrisburg, United StatesSCA Appeals Representative I · Locations: · PA-Harrisburg, IN-Indianapolis, ME-South Portland, TX-Denison, NY-East Syracuse. · This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS Elevance Health Pulse Point locations listed on the requisi ...
-
SCA Appeals Representative I
1 week ago
Elevance Health Harrisburg, United StatesSCA Appeals Representative I · Locations: PA-Harrisburg, IN-Indianapolis, ME-South Portland, TX-Denison, NY-East Syracuse. This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS Elevance Health Pulse Point locations listed on the requisition. ...
-
Team Leader Member Relations
3 weeks ago
Jefferson Health Plans Harrisburg, United StatesWhy Choose Jefferson Health Plans? · We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are c ...
-
Customer Service Representative
2 days ago
Abel Personnel, Inc Harrisburg, United StatesJob Description · Job Description Customer Service Representative · Harrisburg, PA$17.00/HR Are you looking for a company that is dedicated to providing a stable work environment, positive company culture, and career growth? Our client is seeking candidates who can adapt and pro ...
-
Dental Hygienist-NDC- Expert
1 day ago
Health Advocates Network Harrisburg, United StatesDental Hygienist-NDC- Expert · **Pay Rate:** $34 / hour · Minimum Qualifications · Possess a current active Dental Hygienist license; Demonstrate an understanding of utilization review processes. · Basic computer skills to include, but not limited to, Microsoft Office Products. · ...
-
Billing Associate
1 week ago
Physician's Mobile X-Ray Harrisburg, United StatesPosition Summary · Responsible for posting charges, payments and adjustments. Generates electronic or paper claims for submissions and follows up with insurance problems concerning phone calls or written requests for review by performing the duties as described below. · Job Funct ...
-
Enterprisemed Harrisburg, United StatesA Pennsylvania-based medical group is seeking an Associate Surgical Director of Transplant Surgery to develop and grow the Kidney Transplant Program in Central Pennsylvania. · Job Features Associate Surgical Director, Transplant Surgery (Transplant Physicians-General Surgery) · ...
-
Senior Outreach Coordinator
4 weeks ago
MAXIMUS Harrisburg, United States· General information · Job Posting Title · Senior Outreach Coordinator - PA Residents only · Date · Thursday, May 9, 2024 · City · Harrisburg · State · PA · Country · United States · Working time · Full-time · Description & Requirements · The Outreach Coordinator (OC) works as ...
-
Provider Engagement Consultant
1 week ago
Capital BlueCross Harrisburg, United StatesPosition Description: · At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and its why our employees consistently vote us one of the Best Places to Work in PA. · The Provider Engagement Consultant ...
-
Assistant United States Attorney
1 day ago
Department Of Justice Harrisburg, United StatesSummary · This is an open continuous announcement which will be used to fill three immediate positions. First round consideration will be given to applications received by June 12, 2023, 11:59 p.m. EST. Thereafter, review of applications received from this announcement will be co ...
-
Coordinator, Financial Aid
2 weeks ago
Harrisburg Area Community College Harrisburg, United StatesThis position will remain open until filled. There are 2 positions available. · Travel to more than 1 HACC Campus may be required. · Job Summary: This position is responsible for the oversight and administration of an assigned federal, state, and/or institutional financial aid p ...
-
Meat Manager
2 weeks ago
Weis Markets Inc Harrisburg, United StatesOverview · Looking for a company that treats associates with respect, understanding, and appreciation? Looking for a company that is passionate about teamwork and the growth of it's associates and communities? That's WEIS · Job Description: · ESSENTIAL DUTIES AND RESPONSIBILITIE ...
-
Senior Director of Advancement
1 day ago
Diocese of Harrisburg Harrisburg, United StatesPosition Type: · Administration/Director of Advancement · Date Posted: · 1/29/2024 · Location: · Bishop McDevitt High SchoolHIGH SCHOOL SENIOR DIRECTOR OF ADVANCEMENT/DEVELOPMENT · Full-Time · School: Bishop McDevitt High School · City & State: Harrisburg, PA · NATURE OF POSITION ...
-
Asst Dir, Fin Aid Ln/R2T4/State Grant
2 weeks ago
Harrisburg Area Community College Harrisburg, United StatesJob Summary: This position is responsible for the oversight and administration of the following federal, state, and institutional financial aid programs: Loans, R2T4, and State Grant. · Minimum Qualifications: · Bachelor's Degree and 3 years related experience, or a combination ...
-
Deputy Director For planning
1 week ago
City of Harrisburg, PA Harrisburg, United StatesThe City of Harrisburg is seeking qualified applicants to fill the position of Deputy Director for Planning in the Bureau of Planning. This position is responsible for directing and administering the City's Zoning Code and the Subdivision and Land Development Ordinance. This indi ...
-
Deputy Director For planning
2 weeks ago
City of Harrisburg Harrisburg, United StatesThe City of Harrisburg is seeking qualified applicants to fill the position of Deputy Director for Planning in the Bureau of Planning. This position is responsible for directing and administering the City's Zoning Code and the Subdivision and Land Development Ordinance. This indi ...
-
Retirement Benefits Specialist
1 day ago
State of Pennsylvania Harrisburg, United StatesTHE POSITION · Are you an organized self-starter with a penchant for math and analytical challenges? Do you value working with independence while also serving on a small, cohesive team? If so, a Retirement Benefits Specialist position at the State Employees' Retirement System (SE ...
-
Accounts Receivable Specialist
1 day ago
Physician's Mobile X-Ray Enola, United StatesPhysicians Mobile X-Ray · Position Summary · Responsible for posting charges, payments and adjustments. Generates electronic or paper claims for submissions and follows up with insurance problems concerning phone calls or written requests for review by performing the duties as de ...
-
Director of Advancement
3 weeks ago
WITF Harrisburg, United StatesSummary · The Director of Advancement collaborates with the executive leadership of WITF, LNP, and The Steinman Institute of Civic Engagement, and leads an advancement team to set and achieve annual and long-range fundraising goals for the three primary pillars of WITF's vision. ...
SCA Appeals Representative I - Harrisburg, United States - Elevance Health
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
Anticipated End Date:Position Title:
SCA Appeals Representative I
Job Description:
SCA Appeals Representative I
Locations: PA-Harrisburg, IN-Indianapolis, ME-South Portland, TX-Denison, NY-East Syracuse. This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS Elevance Health Pulse Point locations listed on the requisition.
National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.
Pay/Location: the pay for this position varies by location, is set by the government, and is non-negotiable.
The pay is as follows:
How you will make an impact:
Preferred Experience, Skills, and Capabilities:
Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Non-Exempt
Workshift:
1st Shift (United States of America)
Job Family:
SCA > SCA Wage Determination
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.