- ManpowerGroup (Durham, NC)
- **Title:** ** Clinical Appeals Analyst ** **Location: 4613 University Drive Durham NC 27707 United States (Onsite)** **Duration: 6+ months** **Pay rate: ... $41.75/hr (On W2)** **Job Description:** The Clinical Appeals Consultant is responsible for supporting the increased workload in the Claims Department,… more
- Elevance Health (Colorado Springs, CO)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level...medical management review activities which require the interpretation of clinical information. + The analyst may serve… more
- HCA Healthcare (San Antonio, TX)
- …work environment where diversity and inclusion thrive? Submit your application for our Senior Appeals Analyst opening with Parallon today and find out what it ... may vary by location._** We are seeking a Senior Appeals Analyst for our team to ensure...research and resolve High Dollar Technical and Top Dollar Clinical Appeals through understanding of Payer Contract… more
- Corewell Health (Grand Rapids, MI)
- …departments. Serves as a mentor/trainer to other team members. The Senior Appeals Analyst makes decisions on moderately complex issues regarding technical ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- Catholic Health Services (Melville, NY)
- …operations' liaison, collaborating with various entities including payers, clinical , financial and/or operational departments. Duties/Responsibilities: Conducts data ... financial performance through the development of analytics (financial, operational and clinical ) and corrective action plans which improve process flows and… more
- Elevance Health (Louisville, KY)
- …any utilization or medical management review activities that require the interpretation of clinical information. + The analyst may serve as a liaison between ... **SCA Appeals Representative I** **Locations:** This is a virtual...and multiple products, (Part A & B) related to clinical and non- clinical services, quality of service,… more
- The Cigna Group (Nashville, TN)
- **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst ** We will depend on you to communicate some of our most critical information to the ... and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals ...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- Montrose Memorial Hospital (Montrose, CO)
- …of care or service is billed to the patient. About The Career: + The Clinical Denial Analyst is a key contributor within the interdisciplinary Denial Management ... and exposure caused by concurrent and retrospective denials. The Clinical Denial Analyst is considered a ...or denial management. Experience with business letter writing, eg, appeals , preferred. + Must at least be Licensed as… more
- R1 RCM (Detroit, MI)
- …include doing initial reviews, calling insurance companies to resolve authorization and clinical claim denials, writing appeals and letters to insurance ... intelligent automation, and workflow orchestration. As our Denials Senior Analyst , you will help R1 by managing assigned accounts...companies to resolve denials, following up on appeals to the point of exhaustion or payment and… more
- City and County of San Francisco (San Francisco, CA)
- …years of verifiable professional human resources experience, similar to 1241 Human Resources Analyst , in one or more of the following areas of activity: recruitment ... training. Substitutions: Additional qualifying work experience as a professional human resources analyst may be substituted for up to two years of the required… more
- University of Michigan (Ann Arbor, MI)
- HEALTH INFORMATION MANAGEMENT ANALYST II - COMPLIANCE AND AUDITING Apply Now **Summary** Utilize the EPIC Release Module to locate, analyze, and produce medical ... the Office of General Counsel (OGC), the Office of Patient Relations and Clinical Risk, Utilization Review Management, and Revenue Cycle as requested or required.… more
- University of Michigan (Ann Arbor, MI)
- Reimbursement Analyst Senior Apply Now **How to Apply** A cover letter is required for consideration for this position, and it should be attached as the first page ... to this position. **Summary** Michigan Medicine Finance is seeking a reimbursement analyst to provide support for cost report preparation, cost report appeals… more
- CVS Health (Austin, TX)
- …AM - 5:00 PM Central Standard Time (CST), Monday through Friday. The Senior Analyst will act as the Prior Authorization system Subject Matter Expert to provide ... support for the Medical Prior Authorization/ Appeals Operational teams. Primary responsibilities include: Lead projects related to PA system enhancements,… more
- Beth Israel Lahey Health (Burlington, MA)
- …lives.** Under the managerial oversight of the Senior Manager, the Revenue Performance Analyst serves as a primary point of contact for Billing Director, Service ... Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, colleagues and others regarding matters that relate to… more
- Commonwealth Care Alliance (Boston, MA)
- …of the Manager of Billing, Coding, & Provider Documentation the Revenue Cycle Analyst will enhance our FFS & Encounter process, corrective coding, and charge ... to the coding and billing responsibilities, the Revenue Cycle Analyst will work with Clinicians to perform charge entry...various payers to resolve issues of non-payment + Submit appeals as needed + Provides consultation and support to… more
- US Tech Solutions (Wall, NJ)
- **Job Description:** Appeal Analyst RN who will train new hire in the clinical role to complete Utilization Management Appeals and act as an RN I on the ... all Utilization Management medical appeal cases. **Responsibilities:** + Prepares and presents appeals to Provider Appeals Committee in accordance with criteria… more
- System One (Baltimore, MD)
- …of clinical operations, including Care Management, Utilization Management, and Appeals & Grievances. Previous experience using the GuidingCare, Care Manager or ... with clinical operations, including Care Management, Utilization Management, and Appeals & Grievances. + Previous experience using the GuidingCare, Care Manager… more
- UT Health (Houston, TX)
- Remote Senior Compliance Coding Analyst - Emergency Medicine **Location:** Texas Medical Center-Houston, Texas **Hot** **Category:** Legal McGovern Medical School at ... coding staff. Attends meetings. Manages EPIC PB Edits and Requests for denial appeals . Reports review results to the Revenue Cycle Manager, Manager, and/or Medical… more
- Atrius Health (Chelmsford, MA)
- …for responding to payer claim audits including Medicare program, writing complex clinical medical necessity appeals , analysis of claims data and billing ... management support. Gathers, compiles and organizes claims and denial data. Researches clinical and payer informational material for clinical and business… more
- Beth Israel Lahey Health (Burlington, MA)
- …of reporting that provides timely and relevant information on all aspects of clinical appeals , audits, and compliance issues to Revenue Cycle Leadership. ... of the Director, Senior Manager, or Manager of Revenue Cycle, the Revenue Cycle Analyst serves as a primary point of contact for Service Line Directors, Managers,… more