- Kepro (Indianapolis, IN)
- …ensure timely and complaint processing. They will be a crucial resource for the Appeals Team , contribute to quality initiatives, and champion continuous care for ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...Appeals Nurse - LPN/RN to join our growing team . Job Summary: Our Utilization Management Appeals … more
- Abbott (Plano, TX)
- …Our 114,000 colleagues serve people in more than 160 countries. **Sr. Appeals Specialist, Patient Therapy Access Team ** **Position Location: 6600 Pinecrest ... Abbott is a global healthcare leader that helps people live more fully at...**Plano, TX** currently has an opportunity for a **Sr. Appeals Specialist** . This role is responsible for facilitating… more
- Corewell Health (Grand Rapids, MI)
- …and presents education to internal departments. Serves as a mentor/trainer to other team members. The Senior Appeals Analyst makes decisions on moderately ... timely basis. Ensure CMS, decisions are properly implemented. Assist the Lead , Supervisor and/or Manager in coordinating activities and in the development/collection… more
- Actalent (Sacramento, CA)
- Description: + The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of ... a preservice, post-service or claim denial. + The Medi-Cal Appeals and Grievances senior RN will report to the...about in advance.. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions.… more
- Trinity Health (Livonia, MI)
- …denials with the physician advisor to determine if a case should go to the Appeals Team . * Assists other departments in the reimbursement process including, but ... I will be a clinical resource to the UR team and provide leadership in this role based on...for appropriate follow-up. 15. Reviews IP denials with the appeals nurse to determine appropriate status and reimbursement from… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Supervisor, Customer Solution Center Appeals & Grievances is responsible for direct supervision and support of the … more
- LA Care Health Plan (Los Angeles, CA)
- …for all business-related questions/issues raised by staff; escalates to appropriate leader / team when necessary. Recommends and implements process improvement ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category:...The position supervises all aspects of running an efficient team , including hiring, supervising, coaching, training, disciplining, and motivating… more
- Penn Medicine (Bala Cynwyd, PA)
- …Analysts, Senior Compliance Analyst, Nurse Auditor, and Analyst Government Audits and Appeals + Recruit and retain talented results-oriented team . + Develop ... vendor meetings dedicated to product enhancement with internal and vendor management. + Lead hospital and external audit team in utilizing audit software to… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
- CareFirst (Baltimore, MD)
- …Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead our Commercial team and our Government Programs (Medicaid and Medicare) ... and other strategic business partners. We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to… more
- Trinity Health (Farmington Hills, MI)
- …NPR) of a Patient Business Services (PBS) center. Serves as part of a team of clinical payment resolution colleagues at an assigned PBS location responsible for ... Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing… more
- Centene Corporation (PA)
- …grievance and appeal decisions. + Act as subject matter expert regarding grievances and appeals . + Lead Appeals and Grievance Committee + 10% travel ... members as a clinical professional on our Medical Management/Health Services team . Centene is a diversified, national organization offering competitive benefits… more
- Office of the Secretary of the Interior (Arlington, VA)
- …to the Senior Executive Service (SES). Responsibilities The Director Office of Hearings and Appeals is located in the Office of the Secretary of Interior at the ... management and administrative responsibilities with respect to the hearings and appeals functions of the Department in accordance with existing policies,… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials/ appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for A/R, ... Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing...monthly on collections. * Works with others as a team player, as well as supporting staff, and hospital/clinic… more
- Trinity Health (Farmington Hills, MI)
- …practices, and decisions. Performs daily activities as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned ... denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned PBS location responsible for ensuring payments are received on… more
- Board of Veterans Appeals (Washington, DC)
- Summary The Chief Counsel of the Board of Veterans' Appeals (the Board) provides advice and recommendations to the Chairman and Vice Chairman on all issues impacting ... This position is located in the Board of Veterans' Appeals , Office of the Chief Counsel and reports to...and, as a member of the Board's executive leadership team , directly supports the Vice Chairman in the management… more
- Glens Falls Hospital (Glens Falls, NY)
- …MCC's and CC's for reimbursement. In collaboration with Hospital External Review Team (HERT) members, coordinates reviews and responds to internal and external ... Management and/or other Allied Health Profession, plus 3-5 year of lead /supervisory experience Associates Degree with-5-7 years of Inpatient Coding and appeal… more
- Catholic Health Services (Melville, NY)
- …time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! ... plan development and management; contributes to completion of project status reports. Lead meetings with staff and/or leadership to assist in establishing project… more
- CVS Health (Tallahassee, FL)
- …convenient and affordable. Position Summary As a Sr Analyst within the Grievance and Appeals DDAT Technology team you will manage the day-to-day activities of ... are responsible for bridging the gap between the technology team and the business using data analytics to assess...through evaluation of real-time data. . Serve as thought leader for technical business processes, developing systems prototypes that… more
- Trinity Health (Albany, NY)
- …in A/R due to lack of prior authorizations. + Facilitates communication with care team and providers + Appeals denied authorizations for related services, drugs, ... data, system reports, and analytics, supports the needs of the authorization team . Instrumental in developing and implementing strategies to optimize all aspects of… more