- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health ... pre-certification required. Licensure Requirements: None. Apply/Share Job Title INSURANCE APPEALS SENIOR ID 4357425 Facility Covenant Health Corporate… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a Quality Control Senior Manager you want with your current employer? We have an exciting ... plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving… more
- Guardian Life (Nashville, TN)
- …agency relationships, and ensuring customer satisfaction at the highest level. The Senior Disability Insurance Underwriter will work with adjacent departments, ... The ** Senior Disability Underwriter** is responsible for exercising their...entire selection, issue, and administrative process. + Negotiate underwriting appeals with minimal management involvement when collaborating with general… more
- Akumin (Knoxville, TN)
- We are seeking an experienced, strategic, and results-driven Senior Director of Billing and Collections to lead our end-to-end billing operations. This senior ... **Collections & Accounts Receivable** + Direct the collections strategy for both insurance and patient receivables, focusing on reducing aging AR and improving DSO.… more
- BrightSpring Health Services (Nashville, TN)
- …include identifying reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolving billing-related issues. This position ... limited to billing, collections, cash posting, contract analysis, communications with insurance providers, and account management. Perform all end of month closing… more
- HCA Healthcare (Nashville, TN)
- …plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving ... assistance, pet insurance and more. + Free counseling services and resources...plan interpretation and administration. Analyze, research and present benefits appeals and recommendations. In addition, support employee benefits financial… more
- CenterWell (Nashville, TN)
- …includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The ... other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. +… more
- Evolent (Nashville, TN)
- …(NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals . + Ensures documentation of all communications with medical office staff ... overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in… more
- Evolent (Nashville, TN)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Nashville, TN)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Nashville, TN)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Guardian Life (Nashville, TN)
- …manage contracts and financial reimbursement rates with DSOs + Make presentations to senior -level management of DSOs + Identify and report to leadership team on ... for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams to resolve… more
- Evolent (Nashville, TN)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- Evolent (Nashville, TN)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more