- EmblemHealth (New York, NY)
- …to evaluate member needs within the appropriate clinical setting, and as a clinical resource to the non- clinical Appeals staff. Enter and maintain ... Perform clinical and administrative reviews within the Grievance and Appeals department, ensuring accurate administration of benefits, execution of clinical … more
- WMC Health (Valhalla, NY)
- …of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor . Provides continuous education to physicians as needed on ... providers when available within the regulatory timeframe of the request. Provides clinical rational for standard and expedited appeals . Participate in… more
- PacificSource (Springfield, OR)
- …that fully develop and utilize each person's talents and strengths. Provide clinical expertise for physical, behavioral, and oral health utilization management, and ... grievance and appeals . As appropriate, interface with appropriate regulatory agencies to influence and understand policies and procedures. Work in collaboration with… more
- Mental Health Association of South Central Kansas (Wichita, KS)
- Job Type Full-time Description POSITION TITLE: Homeless Clinical Care Specialist REPORTS TO : Coordinator for Peer Support and Integrated Care POSITION OVERVIEW: The ... Homeless Clinical Care Specialist is responsible for providing mobile, community-based integrated mental health and case management services to individuals… more
- Waccamaw Dermatology (Myrtle Beach, SC)
- …and ensure that they are properly and closely monitored. Consults with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate. Processes ... referrals and submit clinical supporting documentation to insurance carriers to expedite prior...physicians and patients as required. Reveiws denials and submit appeals if requested by physician to get them approved… more
- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …Description The Medical Director will play a pivotal role in leading and overseeing clinical and operational programs within NEMS MSO, with a primary focus on the ... Advantage line of business . This role is essential in ensuring clinical excellence, regulatory compliance, and operational efficiency. Key areas of responsibility… more
- R1 RCM (Boise, ID)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor ** , you will help support ... excelling in this remote position. **Here's what you will experience working as a Clinical Appeals Supervisor :** + Track and monitor the workflow of the … more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Ventura County (Ventura, CA)
- Certified Coding Supervisor - Health Information Management Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4892159) Apply Certified Coding ... Supervisor - Health Information Management Salary $94,952.15 - $132,946.07...Information Management (HIM) department related to coding and CDI ( clinical documentation improvement). The ideal candidate will have a… more
- Select Medical (Dallas, TX)
- …A joint venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Liaison (RN, OT, PT, or SLP)** **Full-Time, Monday through Friday 8am - 5pm** ... **Competitive base salary with monthly bonuses!** Clinical Liaisons are advocates who educate and guide patients toward the next level of care, while building… more
- Veterans Affairs, Veterans Health Administration (Louisville, KY)
- …informal complaints of employees and referring others, such as formal grievances and appeals to the supervisor or an appropriate management official. Uses a ... Summary The Lead Health Technician (Telehealth Clinical ) provides an array of complex and specialized...direction relating to the telehealth program. Works with the supervisor to develop assignments for team members in order… more
- Northwell Health (New York, NY)
- …write-offs, adjust downs, bad debts and other delinquent accounts. + Coordinates clinical documentation requests to business office to ensure timely appeals . ... + Develops and implements policies and procedures to facilitate billing and maximize case collections. + Reviews and recommends improvements for financial management of each billing area. + Performs related duties as required. All responsibilities noted here… more
- Veterans Affairs, Veterans Health Administration (Grand Rapids, MI)
- Summary The Social Worker ( Clinical Assessor) is assigned to the Caregiver Support Program (CSP) to work independently with multiple VA healthcare services and ... on specific caregiver needs/issues. Conducts Veteran, caregiver, and family clinical interventions to facilitate the identification of caregiver stress, psychiatric… more
- Mount Sinai Health System (New York, NY)
- …Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical /Technical/Service** + Demonstrates the ability to perform clinical ... + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements...of the hospital staff and extended community. + Notifies Supervisor of obstacles / problems affecting the completion of… more
- Houston Methodist (Houston, TX)
- …required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This ... other team members as advised by the Manager and/or Supervisor . + Identifies denial trends and notifies Supervisor...complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when… more
- WMCHealth (Valhalla, NY)
- …of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor . + Provides continuous education to physicians as needed ... within the regulatory timeframe of the request. + Provides clinical rational for standard and expedited appeals ....Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with payors and/or… more
- Guthrie (Sayre, PA)
- …well as identifies, analyzes and takes the necessary action to submit complex appeals to insurance payers. Reviews all medical chart and account documentation in ... to determine appropriate coding and initiate corrected claims and appeals . Interprets payer guidelines, regulatory guidelines, contractual obligations and works… more
- Stanford University (Stanford, CA)
- …supporting the Clinic.** **The IRC is a nationally recognized full-time clinical education program specializing in deportation defense and immigrants' rights ... to Professor Srikantiah, who will serve as the direct supervisor . This is a hybrid position, with the potential...the San Francisco Immigration Court, the Board of Immigration Appeals , the Ninth Circuit Court of Appeals ,… more
- City and County of San Francisco (San Francisco, CA)
- …validity of audited findings and conclusions and discuss with staff or unit supervisor . 3. Compile and submit statistical and narrative reports and provide evidence ... order to fulfill requests for additional documentation 6. Utilizes clinical interview techniques that include the ability to establish...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
