Jobs at GlobalHealth Holdings, LLC

Provide telephonic case management for complex, high-risk Medicare Advantage members: assess needs, coordinate care and community resources, perform transitions of care, complete SNP MOC activities (HRA, ICP, ICT), educate members and caregivers, and monitor outcomes while ensuring HIPAA compliance.

Lead clinical Appeals & Grievance (A&G) operations, ensuring regulatory and contractual compliance. Manage staffing, scheduling, coaching, performance, and daily workflows. Monitor metrics, handle member escalations, perform first-round quality-of-care reviews, and drive process improvements.

Ensure provider directory accuracy and compliance by verifying provider data, responding to provider inquiries, coordinating credentialing and recredentialing, performing primary source verifications, maintaining credentialing records, and collaborating with vendors and stakeholders to meet CMS and state requirements.

Process contracted and non-contracted Medicare, Medicaid, and commercial claims accurately and timely, review pended claims, resolve customer inquiries, assist with adjustments and claim entry, maintain procedures and PHI confidentiality per HIPAA.