- RWJBarnabas Health (Oceanport, NJ)
- Manager , Appeals (Full- Time) Remote RoleReq #:0000200495 Category:Billing/Collections/Registration Status:Full-Time Shift:Day Facility:RWJBarnabas Health ... System Business Office, 2 Crescent Place, Oceanport, NJ 07757 Job Title: Manager Location: Barnabas Health Corp Department: Appeals Req#: 0000200495 Status:… more
- CareFirst (Baltimore, MD)
- …with dynamic goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and advance departmental capabilities. ... and accreditation requirements. Ensures appropriate and complete resolution of appeals , Regulatory complaints and External review requests. Performs analytics and… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging… more
- Elevance Health (Seattle, WA)
- ** Manager II Grievance/ Appeals (RN)** **Location** : **Hybrid 2:** This role requires associates to be in-office **3** days per week, fostering collaboration and ... locations may be considered. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of… more
- Mount Sinai Health System (New York, NY)
- …issues in an accurate and timely fashion. In collaboration with the Underpayment Team manager , the Senior CBO Appeals Analyst will work to further the CBO's ... **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of...hospital/healthcare environment is required. Advanced knowledge of Epic, Contract Manager , and Microsoft Excel Working knowledge of other Microsoft… more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/ Manager as needed with various projects. + ... sending to appropriate department for review. Follow up on authorizations, claims and appeals with payers. Interact with other departments and work to mitigate and… 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 Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with… more
- Elevance Health (Mason, OH)
- **Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... to Saturday and coverage on certain holidays. The **Nurse Appeals - Medicare** is responsible for investigating and processing...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Provo, UT)
- **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
- Guardian Life (Bethlehem, PA)
- …serve as clinical subject matter expert in all lines of business (STD/LTD/ Appeals ) and products, action planning management, and Guardian systems. This incumbent ... opportunities. This individual will work with the Clinical Team Manager to drive performance and ensure the team meets...+ A minimum of 3+ years of (STD, LTD, Appeals ) claim experience, minimum of 2 years disability experience… more
- Mount Sinai Health System (New York, NY)
- **Job Description** This position serves as Appeals Analyst for Central Billing Office management. Responsible for monitoring contractual allowances, analyzing and ... pursuing appeals opportunities with payors and networks, and reporting performance...and analyzes data in our contract compliance tool (Contract Manager ), EPIC, and payor policy detail for identified payment… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and defend… more
- Aerotek (Tampa, FL)
- **Description** PURPOSE: The Clinical Appeals Specialist completes research basic analysis and evaluation of member and provider disputes regarding adverse and ... adverse coverage decisions. The Clinical Appeals Specialist utilizes clinical skills and knowledge of all...State Licensure Upon Hire Req CCM - Certified Case Manager Upon Hire Pref LNCC - Legal Nurse Consultant… more
- Elevance Health (Roanoke, VA)
- …Able to work independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings in accordance with ... report reopenings. + Under guided supervision, participate in completing more complex appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more
- Ochsner Health (New Orleans, LA)
- …Health System (OHS). Functions as a liaison with the department Vice President/ Manager of Regulatory Audits and ensures compliance with regulations and alternative ... level of care options affecting OHS revenue as it relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in Nursing **Work Experience** Required - 3 years Hospital based… more
- Rush University Medical Center (Chicago, IL)
- …+ Updates the Woman's Board website and social media accounts in conjunction with the Manager , Events & Appeals + Shares office administrative tasks with the ... and the EVP of Administration, the Membership and Operations Manager is responsible for all communication and events involving...Manager , Events & Appeals + Other duties as assigned Rush is an… more
- Helio Health Inc. (Syracuse, NY)
- …when a question or concern arises. + Communicates insurance trends and unresolved appeals to the billing manager for further action. + Demonstrates adaptability ... files necessary for research and documentation. + Researches open claims and processes appeals when necessary. Follows up on patient and insurance company issues in… more
- Mount Sinai Health System (New York, NY)
- …to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting and other ... **Job Description** The Nursing Clinical Manager (NCM) for Case Management is responsible for...performance evaluation, performance improvement, and staff education. The NCM Manager serves as a resource/mentor for Case Managers, Social… more
- NTT America, Inc. (Plano, TX)
- …and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a **Medicare ... Appeals Clinical Leader** to lead service delivery engagements and...service delivery engagements and improve end-to-end delivery of Medicare Appeals . Desire experience specifically for processes for clinical … more
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