- Denver Health (Denver, CO)
- We are recruiting for a motivated RN Health Plan Grievance & Appeals Specialist - Denver Health Medical Plan (Must Be a Colorado Resident) to join our team! We ... Job Summary Under minimal supervision, the Registered Nurse, Grievance & Appeals is responsible for assessing and completing appropriate documentation for tracking… 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...programs. Assist clients in completing Medicaid applications, renewals, and appeals , including gathering required documentation. Utilize trauma-informed, harm-reduction, and… more
- Joints In Motion Medical LLC (Pewaukee, WI)
- …DME products and services. *Obtain prior authorizations and address denials and appeals . *Review clinical documentation to determine medical necessity. *Work ... LLC (JIMM) is hiring a DME Medical Insurance Benefit Specialist to join our orthopedic-focused team. This role is...(DME), and the ability to navigate insurance denials and appeals processes. Experience in a medical office and familiarity… more
- Mount Sinai Hospital (New York, NY)
- Job Description Utilization Management Specialist MSH Case Management FT Days This position is responsible for coordinating requests for clinical information ... facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials. Responsibilities Admission:… more
- Vision Integrated Partners (Chesterfield, MO)
- …us in successfully achieving our goal. We are currently seeking a Medical Billing Specialist to join our team. We are a busy ophthalmology practice; therefore, the ... companies either electronically or by paper. Answers questions from patients, clinical staff, and insurance companies. Identifies and resolves patient billing… more
- AltaMed Health Services Corporation (Montebello, CA)
- …a calling that drives us forward every day. Job Overview The Quality Specialist is a California licensed nurse responsible for collecting, analyzing, and mining ... all managed care activities (eg, UM, CM, Claims, Member Services, Appeals and Grievances, Credentialing, Provider Network) tracks and trends specified… more
- Diverse Lynx (San Francisco, CA)
- Job Description & Responsibilities: The Grievances & Appeals Specialist plays a critical role in supporting patients and families by investigating complaints, ... Experience: Minimum 2 years of recent relevant experience in grievances, appeals , or patient advocacy. Skills Required: Strong oral and written communication… more
- Waccamaw Dermatology (Myrtle Beach, SC)
- Description Job Summary: The Prescription Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance ... necessary third party authorization requests. The Prescription Prior Authorization Specialist has direct over-the-phone interaction with patients and is an… more
- AndHealth (Indianapolis, IN)
- Pharmacy Liaison (Patient Engagement Specialist ) Full Time Indianapolis, IN AndHealth is on a mission to radically improve access and outcomes for the most ... have access to the care they deserve. We are looking for Patient Engagement Specialist to play an important role at AndHealth. This is an onsite position located… more
- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist , is responsible for managing client medical ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Accounting/Finance Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...manner. This position will focus on quality review of non- clinical grievance and appeals cases for all… more
- Robert Half Accountemps (Los Angeles, CA)
- …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , will be in ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your… 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 ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Elevance Health (Chicago, IL)
- ** Appeals Referral Specialist ** **Location :** **Hybrid** - This role requires associates to be in-office **3 days per week** , fostering collaboration and ... - Friday 10:30 am - 7:00 pm CST The ** Appeals Referral Specialist ** is responsible for providing...Specialist ** is responsible for providing support to a clinical team in order to facilitate the administrative components… more
- Elevance Health (Irving, TX)
- …our specialty pharmacies, our infusion centers, and the home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - ... weeks/30 days at the Plano, TX office. The **Referral Specialist II** is responsible for providing support to a... II** is responsible for providing support to a clinical team in order to facilitate the administrative components… more
- Molina Healthcare (Midvale, UT)
- …position, home office with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct ... for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that… more
- LA Care Health Plan (Los Angeles, CA)
- …Prepares template determination/education letters for members and providers. Duties Provide non- clinical support to the Customer Solution Center Appeals and ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager, assist with soliciting non- clinical information… more
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