- Covenant Health (Lubbock, TX)
- …and retain the best people, we must empower them.** **Works collaboratively with Case Management (CM) Leadership, Case Managers (CM), Complex Discharge Planners ... 3 or more years of experience in managed care claims /reimbursement setting or experience working in another other healthcare...1 or more years of experience in managed care claims / reimbursement + 1 or more years of… more
- Commonwealth of Pennsylvania (PA)
- …+ Four years of experience in the determination of unemployment compensation claims , including adjustments, overpayments, and appeals supplemented by 6 college ... fact that explain all legal issues present in the case and provide reasoning for decisions which reflects your...do you possess in the determination of unemployment compensation claims , including adjustments, overpayments, and appeals ? +… more
- Texas Veterans Commission (Midland, TX)
- …rulings, and state law in the adjudication process. . Prepares and files claims and appeals with supporting evidence for successful adjudication. . Advises ... Financial Operations* **Organization:** **TEXAS VETERANS COMMISSION* **Title:** *TVC - Claims Benefit Advisor (Veterans Services Representative I)* **Location:**… more
- HCA Healthcare (Salem, VA)
- …want to join an organization that invests in you as a Workers Compensation Claims Resolution Specialist? At Parallon, you come first. HCA Healthcare has committed up ... difference. We are looking for a dedicated Workers Compensation Claims Resolution Specialist like you to be a part...our team. **Job Summary and Qualifications** The Revenue Cycle Representative will process claim files for payment from Health… more
- University of Rochester (Rochester, NY)
- …edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims , including compiling all necessary information and ... overbooking and rearranging of surgeon's Operating Room schedules based on case complexity and medical urgency. + Authorizes rescheduling when cancellations occur… more
- Cardinal Health (Lansing, MI)
- …needs of the patient and/or program + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance ... + Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- Independent Health (Buffalo, NY)
- …internal and external service groups. + Coordinate with external agencies to prepare case files when needed for external appeals . Departmental Support + Assist ... and consistent review and investigation of provider and/or member complaints and/or appeals . The Contractual Reviewer-Senior will be required to rely on their… more
- Fallon Health (Worcester, MA)
- …and appeals , which includes, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from ... LinkedIn. **Brief summary of purpose:** The Fallon Health (FH) Appeals and Grievance process is an essential function to...FH members and FH with their complaints regarding denied claims , referrals, membership, and benefit issues as well as… more
- City and County of San Francisco (San Francisco, CA)
- …and acts on behalf of an individual's interests and/or functions as the representative payee - both under the Office of the Public Guardian. Responsibilities include ... investigations and case management in order to execute fiduciary duties such...Office of the Public Administrator, and/or + As the representative payee to manage funds from Social Security Administration… more
- State of Colorado (Montrose County, CO)
- …to ensure protection against fraud and waste of state funds in allocating claims and prevention materials and has the authority to implement changes to ensure ... CPW Commission meetings as staff authority on Game Damage claims and damage prevention. This position is a resource...coordinates with Area/Region staff and AG's office on denial appeals . Provides Game Damage training to new CPW District… more
- Wounded Warrior Project (Phoenix, AZ)
- …military service. The NSO guides and manages the preparation and processing of all claims and subsequent appeals through the Department of Defense (DoD) and ... the DoD and DVA. + Prepare briefs for pending appeals located at the local VA Regional Office level....laws, regulations, and benefits. + Maintain and update WWP case management electronic tracking systems. + Develop community support… more
- Independent Health (Buffalo, NY)
- …status and management. + Out-of-network redirection and negotiation awareness. + Case and disease management referrals. + Repatriation. + Member website, app ... and portal assistance. + Appointment scheduling. + Contractual and clinical appeals . + COB/Dependent verification. + Subrogation calls. + Interdepartmental call flow… more
- Fresenius Medical Center (Dallas, TX)
- …and/or liability oriented questions or issues to multiple divisions of FME. Litigates claims . + Develops and directs overall case management and strategy from ... internal FME business clients in negotiations, pre-suit matters, litigation and appeals . Provides litigation support on the company's behalf and coordinates… more
- Defense Logistics Agency (New Cumberland, PA)
- …Counsel and assists in the substantive development, investigation, analysis, and case preparation involving various legal matters. Assists in the evaluation and ... contract cases, and court and administrative hearings regarding complaints, appeals , protests, investigations, and mediation. Investigates, gathers, compiles, classifies,… more
- Phoenix House (Wainscott, NY)
- …for patients receiving behavioral health services. The Manager will monitor claims and approvals to ensure uninterrupted service provision. This position is ... discharge information to insurance companies . Initiate and resolve appeals . Work with the clinical and nursing teams...information needed for reviews . Participate in weekly clinical case conferences . Utilize OASAS LOCADTR (Level of Care… more
- LifePoint Health (Richlands, VA)
- …and the RAC reviewers. Coordinates all files, response letters and files appropriate appeals , necessary in collaboration with Case Management and the physicians. ... RHC State Surveyor: Policies; Staff Licensure and Credentials. * Coordinates Risk case review, in conjunction with the Operations Team, when applicable. * Notifies… more
- Guardian Life (Bethlehem, PA)
- …and key resource for day-to-day tier 3 escalations related to eligibility, enrollment, and claims . This includes but is not limited to: + Overseeing the Field ... Representative billing process and collaborating with internal stakeholders and...escalation contact to resolve plans/member escalations by leveraging the case management system. + Performing as the secretary for… more
- Avera (Pierre, SD)
- …government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage ... complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff. + Work with… more