- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Trenton, NJ)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... appeal. **Work Arrangement:** + Hybrid in Philadelphia **Responsibilities:** + Process appeals , ensuring compliance with all regulatory milestones + Review medical… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... communication with management regarding billing and coding issues including documentation, denials/ appeals , etc.* Follows up on assigned insurances on a monthly… more
- Sharecare (Trenton, NJ)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals , take appropriate action with responses (including correcting data and… more