- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials and … more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging… more
- New York State Civil Service (Liverpool, NY)
- …imposed by the Workers' Compensation Law* Assist in the assignment of cases when the Appeals Unit Manager is absent for extended periods* Assist the Legal ... Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) Occupational Category Legal Salary Grade NS...requests* Prepare and timely file clearly written and persuasive appeals , rebuttals, and memos of law with reference to… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager , Appeals and Grievances the Supervisor, Appeals ... and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the ...ensure all cases are processed timely. + Work with Manager to ensure that employees have the requisite information… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager , the Appeals & Grievances QA Auditor audits the quality ... of letters and keyed entries from the Grievance and Appeals systems. Checks cases built by other associates to ensure highest level of quality and timeliness.… more
- Elevance Health (Durham, NC)
- ** Manager II Grievance/ Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... unless an accommodation is granted as required by law._ The ** Manager II Grievance/ Appeals ** responsible for management oversight of grievances and appeals … more
- State of Minnesota (St. Paul, MN)
- …join a legal team making a difference for Minnesotans! Reporting to the Paid Leave Appeals Manager , you're key to the overall success of our division. **Key ... + **Division/Unit** : Paid Family & Medical Leave / Appeals Hearings Unit + **Work Shift/Work Hours** : Day...that may be appealed to the Minnesota Court of Appeals . + **Timely Execution of Duties:** Must hold multiple… more
- State of Minnesota (St. Paul, MN)
- …join a legal team making a difference for Minnesotans! Reporting to the Paid Leave Appeals Manager , you're key to the overall success of our division. **Key ... + **Division/Unit** : Paid Family & Medical Leave / Appeals Hearings Unit + **Work Shift/Work Hours** : Day...that may be appealed to the Minnesota Court of Appeals . + **Timely Execution of Duties:** Must hold multiple… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements.../ Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and… more
- Mount Sinai Health System (New York, NY)
- …issues in an accurate and timely fashion. In collaboration with the Underpayment Team manager , the Senior CBO Appeals Analyst will work to further the CBO's ... **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of...hospital/healthcare environment is required. Advanced knowledge of Epic, Contract Manager , and Microsoft Excel Working knowledge of other Microsoft… more
- Pacific Medical Centers (Renton, WA)
- …performance tracking systems, and ensure adherence to financial targets. + **Integrity and Appeals Manager :** Oversee the integrity program and appeals ... presentations, and make decisions on post-service, network, and benefit appeals . + **Customer Satisfaction Advocate:** Actively solicit customer feedback, resolve… more
- Molina Healthcare (San Antonio, TX)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and ... * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing... and grievance processing/resolution, including 2 years in a manager role. * Experience reviewing all types of medical… more
- Molina Healthcare (St. Petersburg, FL)
- …leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... complaints, appeals , and claim disputes, and communicating resolution to members,... and grievance processing/resolution, including 3 years in a manager role. * Experience with Medicare Regulations, Medicare Duals,… more
- State of Colorado (Denver, CO)
- Administrative Assistant II (Criminal Appeals ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5023135) Apply Administrative Assistant II ... (Criminal Appeals ) Salary $40,036.50 - $50,983.50 Annually Location Denver, CO...establish an eligible list for referral to the hiring manager for final consideration. The State of Colorado believes… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager , Nursing positions are required ... HEALTH FACILITIES PROGRAM MANAGER , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4626091) Apply HEALTH FACILITIES PROGRAM MANAGER… more
- Molina Healthcare (Midvale, UT)
- …office with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Munson Healthcare (Traverse City, MI)
- …and verbal communication skills. ORGANIZATIONAL RELATIONSHIP . Report to the Manager of Utilization Management and works closely with the Utilization Management ... and Appeals team . Interacts independently with all Munson Health...and sorts incoming communication to the Utilization Management and Appeals department, including faxes, emails, physical mail, and phone… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and defend… more
- Idaho Division of Human Resources (Boise, ID)
- …regarding appeals /hearings processes. + Provide support to the Hearing Manager as needed. Minimum Qualifications: + Some knowledge of legal terminology. ... COPP - Appeals /Hearings Technician Posting Begin Date: 2025/07/23 Posting End...reports. This position also provides support to the Hearing Manager during Parole Hearing Sessions. Responsibilities: + Perform a… more