- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the ... full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This ... all follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for clinical appeals as needed. + Files… more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... + Must have experience with Milliman Care Guidelines and/or InterQual. Hours/Shift + Fully remote role + Days: Sunday - Thursday + Hours: 8:00am - 4:00pm *Additional… more
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... 44, MOON, Connecticut notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. *… more
- University of Washington (Seattle, WA)
- … Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures ... clinical denials to determine next steps. Additionally, they conduct appeals as appropriate by reviewing medical necessity, and/or reconciling coverage-related… more
- Option Care Health (Columbia, SC)
- …Assists with Billing and Collection Training and completes "second level" appeals to payers. **Job Description:** **Job Responsibilities:** + Submits timely, ... accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are… more
- State of Massachusetts (Boston, MA)
- …Commonwealth of Massachusetts is seeking candidates for a Public Records Specialist with the Public Records Division.The Public Records Division (Division) ... of Records (Supervisor), the Division processes and issues determinations on appeals from requestors denied access to government records; responds to questions… more
- State of Colorado (Denver, CO)
- Rural Strategies Specialist - Term Limited Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5173062) Apply Rural Strategies Specialist - ... only open to Colorado state residents. This position is remote and serves the following locations highlighted in yellow...official appeal form, signed by you or your representative. Appeals to the State Personnel Board or the State… more
- Clark County, NV (Las Vegas, NV)
- JUVENILE DETENTION SPECIALIST I/II Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/5178061) Apply JUVENILE DETENTION SPECIALIST I/II ... is seeking qualified candidates to apply for Juvenile Detention Specialist I/II (JDS). This position is responsible for the...emotional environments. Specified positions may be assigned to a remote work site at high elevation. May be subject… more
- Sanford Health (SD)
- …clinical documentation, and interpreting medical policies. The As a lead position, lead appeals and denial specialist this role will additional support the leads ... to the work of health and healing across our broad footprint.** **Facility:** Remote SD (Central Time) **Location:** Remote , SD **Address:** **Shift:** 8 Hours… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist ** **Location: Fully remote ** **Duration: 12 months contract** **Job Description:** + Prior Authorization ... Specialist takes in-bound calls from providers, pharmacies, members, etc...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
- State of Colorado (Denver, CO)
- Regional Water Coordination Specialist (PSRS II) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5167222) Apply Regional Water Coordination ... Specialist (PSRS II) Salary $76,104.00 - $112,404.00 Annually Location...and sick leave + Flexible work schedule options and remote -work options + Career advancement opportunities throughout the State… more
- Choctaw Nation of Oklahoma (Durant, OK)
- **Job Purpose or Objective(s):** Responsible for conducting appeals , inquiries, evaluations, and investigations regarding possible compliance issues/concerns within ... manager. **Pay Range: $82,000-$92,000 | Hybrid Schedule of 20% On-Site and 80% Remote | Monday-Friday, 8:00 AM-4:30 PM** **Primary Tasks:** 1. You will monitor and… more
- US Courts (Washington, DC)
- Summary The Information Technology Support Specialist provides technical support to judges, chambers staff, and court staff in the areas of installing, configuring, ... issues including Microsoft 365 applications, virtual desktop infrastructure, and remote access solutions. Install, configure, and maintain hardware, cloud-based… more
- State of Colorado (Greeley, CO)
- Behavioral Health Specialist , Social Work / Counselor III - Platte Valley Youth Services Center Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5193846) Apply Behavioral Health Specialist , Social Work / Counselor III - Platte Valley Youth… more
- State of Colorado (Golden, CO)
- Behavioral Health Specialist , Social Work/Counselor II - Campus at Lookout Mountain YSC Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5193786) ... Apply Behavioral Health Specialist , Social Work/Counselor II - Campus at Lookout Mountain...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Certified Therapeutic Recreation Specialist (CTRS) - Clinical Therapist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5167891) Apply ... Certified Therapeutic Recreation Specialist (CTRS) - Clinical Therapist II Salary $49,728.00 -...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Board Certified Behavior Analyst - (Clinical Behavioral Specialist II) - Wheat Ridge Regional Center Print ... Apply Board Certified Behavior Analyst - (Clinical Behavioral Specialist II) - Wheat Ridge Regional Center Salary $64,728.00...may be required. + Travel: Position must travel to remote work sites and may transport the individuals served.… more
- State of Colorado (Denver, CO)
- Commodity Supplemental Food Program Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186516) Apply Commodity Supplemental Food ... Program Specialist Salary $71,544.00 - $93,012.00 Annually Location Denver, CO...administering sanctions. + Travels to agencies throughout Colorado including remote locations to review each agency against set standards… more