- Monster (Allentown, PA)
- …for medical necessity and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that ... as necessary to ensure that documentation is entered and transmitted to insurance carriers within acceptable timeframes to comply with appeal deadlines. Provides… more
- Genmab (Berkeley Heights, NJ)
- …for the patient (including caregivers) and the healthcare provider (including their office staff ) to navigate through insurance coverage and access of the ... be the dedicated point of contact for prescribers, office staff members, patients and caregivers as it pertains to...in case management, phone-based support work and the health insurance landscape. Patient Service Specialists are critical in the… more
- Monster (Findlay, OH)
- …the initial denial notifications for claims that have been received by the insurance but have been partially or fully denied for reimbursement from the provider. ... appeal. Duty 2 Carries out appropriate research and analysis to help with the appeals process and stay informed of best practices and policy changes. Duty 3:Conducts… more
- HireMaster (Lincoln, NE)
- …team which includes, but is not limited to, hospital patient care staff , physicians, patient support and family to ensure the patients hospital stay ... meets medical necessity and insurance authorizations are obtained in order to facilitate the...algorithm. 6. *Participates in concurrent and retrospective denials and appeals process by researching issues surrounding the denial, participating… more
- Monster (Allentown, PA)
- …network. Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review ... documentation, CCI/LCD, carrier policy and utilization of coding software applications.The appeals process may include collaboration with the Claim Editing Manager,… more
- Monster (New Paltz, NY)
- …provide support to senior representatives to facilitate the collections of accounts receivable. Staff in this position must be able to complete basic tasks within ... to senior representatives such as mailing paper claims, preparing spreadsheets for appeals , or maintaining data spreadsheets as directed by the manager (s).… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Martin's Point Health Care (Portland, ME)
- …with appeals leadership and Compliance. + Identify, develops, and provides staff education/training related to appeals . + Maintains education, awareness, and ... + Independently partners with Medical Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial management. ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on clinical documentation… more
- Catholic Health Services (Melville, NY)
- …advisors and facility departments. Develops/validates daily work lists for Utilization and Appeals Manager. Assist with all insurance and regulatory audits and ... Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
- Elevance Health (Norfolk, VA)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in...approve or summarize and route to nursing and/or medical staff for review. + The grievance and appeal work… more
- Centene Corporation (Phoenix, AZ)
- …Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve all State inquires related to ... complaints, grievances and appeals . + Review and process member and provider grievances...as liaison between member, provider regulatory agencies and internal staff . + Correspond with key individuals regarding grievance and… 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 a formal appeals… more
- Elevance Health (Durham, NC)
- **Medical Director-Pain Management/Anesthesia Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required ... as required by law. The **Medical Director Pain Management/Anesthesia Appeals ** is responsible for the review of appeals...of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for… more
- City of New York (New York, NY)
- …enthusiastic Trial Preparation Assistant, Level II (TPA II) to assist Appeals Bureau Assistant District Attorneys with post-conviction matters. JOB RESPONSIBILITIES: ... court - Help maintain and make entries in various Appeals Bureau databases - Perform all other duties as...communication skills and ability to interact professionally with court staff , agency staff , and external agency … more
- Elevance Health (Indianapolis, IN)
- …for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to identify ... to providers regarding coding and fee schedule updates. + Trains customer service staff on system issues. + Works with providers contracting staff when… more
- City of New York (New York, NY)
- …enthusiastic Trial Preparation Assistant, Level II (TPA II) to assist Appeals Bureau Assistant District Attorneys with post-conviction matters. JOB RESPONSIBILITIES: ... court services - Ability to effectively and professionally communicate with court staff and judges - Excellent time management skills Strong desire and ability… more
- St. Luke's University Health Network (Allentown, PA)
- …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 diagnosis ... MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive… more
- Johns Hopkins University (Middle River, MD)
- …the collection of unpaid third-party claims and independent resolution of complex appeals , using various JHM applications and JHU/ PBS billing applications. Will ... high-cost procedures. Will incorporate research findings on medical policy into appeals documentation. Communicates with payers to resolve issues and facilitate… more
