- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator .** This role collaborates with clinical review staff, medical ... to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate documentation and detailed recordkeeping of notifications to members… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …we serve through our Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator ** - **Clinical Appeals ** performs prospective review (benefit ... advisory/ prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. The incumbent partners with Medical Directors and… more
- Universities of Wisconsin (Whitewater, WI)
- …through the internal application process. Position Title: Assignments and Billing Coordinator Job Category: Academic Staff Employment Type: Regular Job Profile: ... Housing Coordinator II Job Duties: The Assignments and Billing ...complicated and sensitive housing-related issues, policy questions, requests, and appeals , including matters related to student resident disabilities and… more
- Jobleads-US (Chicago, IL)
- Description The Billing Coordinator reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, ... guidelines and all other regulatory and accreditation standards. The Billing Coordinator is responsible for processing charges, payments and/or adjustments for all… more
- Jobleads-US (Chicago, IL)
- …and reviews common errors or misses with physicians and leadership. The Billing Coordinator reflects the mission, vision, and values of NM, adheres to the ... guidelines and all other regulatory and accreditation standards. The Billing Coordinator is responsible for processing charges, payments and/or adjustments for all… more
- Jobleads-US (Miami, FL)
- …of CPT, ICD-10, charge entry, and claims management processes. Knowledge of appeals process and researching denials as applicable to business needs. Possesses ... effective verbal and written communication skills. Knowledge of Microsoft Systems Word, Excel, Power Point and Access is a must. Must be detail-oriented team player with excellent written and communication skills. Background in coding experience in other… more
- The Crucible (Oakland, CA)
- …HR generalist, administrative support specialist, full-charge bookkeeper or purchasing coordinator . Intermediate to advanced proficiency with QuickBooks or similar ... include why you would be a good fit, what you'd bring to The Crucible and what appeals to you about this position. Due to the size of our team and the physical… more
- Catholic Health Services (Melville, NY)
- …Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization ... management and appeals functions to include coordination of specific process and payment related activities. Position Responsibilities: + Prepares necessary… more
- Dignity Health (Rancho Cordova, CA)
- …This position is hybrid in-office and work from home.** **Position Summary:** The Appeals and Grievances Coordinator is responsible for supporting the appeals ... department team members by managing and coordinating the appeals and grievance process. This role involves: - facilitating...and grievances. Acting a subject matter expert (SME), the Coordinator will work closely with internal teams and external… more
- Nuvance Health (Danbury, CT)
- …Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders in ensuring ... role is instrumental in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for the Nuvance Health… more
- CVS Health (Phoenix, AZ)
- …+ Verify caller enrollment status with Mercy Care Plan. + Collect and document accurate demographic information from members or callers, as well as from Mercy Care ... systems. + Confirm details such as whether members receive special assistance (applicable to members with serious mental illness). + Utilize the QuickBase database to complete intake forms, ensuring documentation of members' reasons for calling is thorough and… more
- CVS Health (Baton Rouge, LA)
- …Prepares information and reports needed to address matters regarding complaints, appeals , and grievances. Carries out policies, procedures, and programs to ensure ... Prepares information and reports needed to address matters regarding complaints, appeals , and grievances. Carries out policies, procedures, and programs to ensure… more
- CVS Health (Harrisburg, PA)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. + Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. +… more
- CVS Health (Springfield, IL)
- …+ Prepares information and reports needed to address matters regarding complaints, appeals , and grievances. Carries out policies, procedures, and programs to ensure ... Prepares information and reports needed to address matters regarding complaints, appeals , and grievances. Carries out policies, procedures, and programs to ensure… more
- CVS Health (Phoenix, AZ)
- …from multiple business units. Ensure timely, customer focused response to complaints/ appeals . Identify trends and emerging issues and report and recommend solutions. ... in the United States. **What you will do** Review and process appeals filed by participating providers. Assist with adherence to regulatory requirements, conducts… more
- City of New York (New York, NY)
- …its work. Job Duties and Responsibilities: - Serve as the Reasonable Accommodations Appeals Unit coordinator and processing incoming requests. - Maintain an ... agencywide list of Executive Assistants for agency leadership that is updated and shared on a monthly basis. - Serve as a co-preparer for travel alongside the Operations Manager on travel for the Commissioner and other COH office staff. - Maintain the… more
- Crossroads Hospice & Palliative Care (Green, OH)
- …backgrounds + Problem-solving skills to research and resolve discrepancies, denials, appeals , collections Billing Coordinator Schedule & Benefits: + Schedule: ... we can create lasting impacts that transcend medical treatment. Billing Coordinator Responsibilities: + Obtain referrals and pre-authorizations as required for… more
- Centene Corporation (Olympia, WA)
- …and improved member outcomes. + Experience as a Utilization Management (UM) Specialist, Appeals Coordinator , or Care Coordinator + Previous experience ... working with a Managed Care Organization (MCO) + Strong understanding of health-related social needs (HRSN) and associated terminology + Ability to work independently, manage priorities effectively, and take on additional responsibilities as needed +… more
- CommonSpirit Health (Englewood, CO)
- …are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and state regulations, ... audit-ready case files with denial rationales and P2P documentation, ensuring successful appeals across all levels (1-5), including IRO and ALJ reviews, utilizing… more
- State of Colorado (Denver, CO)
- Chronic Disease Sustainability and Policy Coordinator - Term Limited Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5108358) Apply Chronic ... Disease Sustainability and Policy Coordinator - Term Limited Salary $72,000.00 - $77,688.00 Annually...official appeal form, signed by you or your representative. Appeals to the State Personnel Board or the State… more
