- Highmark Health (Richmond, VA)
- …of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... all involved parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross… more
- CVS Health (Richmond, VA)
- …with heart, each and every day. **Position Summary** The Senior Network Relations Analyst is responsible for the accurate and timely validation and maintenance of ... responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required… more
- Elevance Health (Richmond, VA)
- **Provider Payment Appeal Analyst II** **Location:** This role enables associates to work virtually full-time from **Virginia** , with the exception of required ... am - 6 pm EST The **Provider Payment Appeal Analyst II** is responsible for supporting the Payment Dispute...and may serve as a liaison between grievances & appeals and /or medical management, legal, service operations and/or… more
- Evolent (Richmond, VA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple ... Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances) + Using analytical tools to integrate various data… more
- Intermountain Health (Richmond, VA)
- …updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7. ... Complies with all CMS, Federal and State regulations, and payor guidelines, and ensures consistent and compliant application with charge/coding capture, charge editing, and audit and reimbursement practices. Researches and collaborates on regulation updates to… more
- Intermountain Health (Richmond, VA)
- **Job Description:** The HIM Coding Audit Training Analyst Coordinator provides advanced training to hospital coding staff, compliance, CDI, physicians, and clinical ... providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding… more