- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… more
- Centene Corporation (Salem, OR)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... Time (PST). (PST) residents strongly preferred **2+ years grievance or appeals , claims, managed care, or relevant experience.** **Position Purpose:** Analyze and… more
- Cardinal Health (Salem, OR)
- …obtain authorization for all requested procedures, tests, drugs, etc. The Senior Coordinator , Benefits Eligibility and Authorization may be asked to perform other ... to not delay patient care. + Complete any pre-service appeals to obtain paying approval based on medical necessity....medical necessity. + Communicate effectively with all RCM and clinical staff to ensure appropriate treatment can be provided,… more
- Highmark Health (Salem, OR)
- …obtain necessary and/or additional information when necessary. + Consult with staff clinical pharmacist for guidance and assistance as necessary. + Document all ... through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. +… more
- Intermountain Health (Salem, OR)
- … provides advanced training to hospital coding staff, compliance, CDI, physicians, and clinical staff. This Coordinator serves as a subject matter expert for ... audit and monitor all areas of hospital coding. The coordinator works with providers and clinical staff...compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades… more