- Monster (Orange, CA)
- Job Title: Temporary - Grievance & Appeals Nurse Specialist Department: Grievance & Appeals Work Arrangement: Onsite (Full Office) Schedule: Monday - Friday ... About the Role: Client is seeking a Grievance & Appeals Nurse Specialist (Temporary) to join our...with regulatory standards and organizational policies. You will investigate appeals , prepare clinical case narratives, and represent… more
- Monster (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. Coordinates RAC … more
- Monster (Findlay, OH)
- PURPOSE OF THIS POSITION The purpose of the Denials Management Specialist is to review the initial denial notifications for claims that have been received by the ... or fully denied for reimbursement from the provider. The specialist is expected to identify the root cause of...including but not limited to, patient access, provider clinics, clinical departments, managed care, billing, coding, and compliance to… more
- Monster (Allentown, PA)
- …documentation, CCI/LCD, carrier policy and utilization of coding software applications.The appeals process may include collaboration with the Claim Editing Manager, ... Physician, Specialty Coder, AR specialist or Auditor/Educator.Demonstrate the ability to formulate an appeal...the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on … more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... projects. + Independently partners with Medical Directors and other clinical support staff on appeals requiring ...Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts… 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: Administrative, HR, Business Professionals Department: CSC ... 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
- Healthfirst (FL)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + ... Work within a framework that measures productivity and quality for each Specialist against expectations + Work independently exercising judgment starting the case… more
- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity to ... make an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something...(same for training) + Weekly paycheck + Dedicated Onboarding Specialist & Recruiter + Access to Adecco's Aspire Academy… more
- Molina Healthcare (Omaha, NE)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… 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
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... Reporting to the Prior Authorization Superv isor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- State of Colorado (Denver, CO)
- Certified Therapist Recreation Specialist (CTRS) - Clinical Therapist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5082555) Apply ... Certified Therapist Recreation Specialist (CTRS) - Clinical Therapist II Salary...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Hartford HealthCare (Farmington, CT)
- …. Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory ... Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS),and/or Certified Clinical Documentation Specialist … more
- HCA Healthcare (Brentwood, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock… more
- City and County of San Francisco (San Francisco, CA)
- …assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
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