- Kepro (Richmond, VA)
- …for health solutions in the public sector. Acentra seeks a UM Reviewer & Appeals Coordinator RN/LCSW (Remote within Virginia) to join our growing team. Job ... in a blended role as a clinical reviewer and appeals coordinator . In the clinical reviewer role...and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence. +… more
- Magellan Health Services (Boise, ID)
- …ensuring documents meet standards and are accurate. General Job Information Title Appeals Coordinator Grade 19 Work Experience - Required Customer Service ... Coordinates appeals process as assigned, attends to risk management...requests. In some cases may be combined with Grievance Coordinator functions. + Maintains a caseload and monitors day… more
- TEKsystems (Houston, TX)
- Hiring For Grievance & Appeals Coordinator ! 100% REMOTE - Texas Note: Candidates from Texas can only apply! Candidates who are having 5+yrs of experience in ... meet service level metrics, adherence, daily productivity. + Answering denial /appeal related questions from members or providers. + Member...titles or background work well in this role? * Appeals Coordinator / Case Manager * Medical… more
- Universal Health Services (Chicago, IL)
- Responsibilities JOB SUMMARY: Responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals , Standard ... Reviews, and State Fair Hearings. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services… more
- CVS Health (Phoenix, AZ)
- …Mercy Care lines of business. Required Qualifications -Research incoming electronic disputes/ appeals to identify if appropriate for unit based upon published ... Sponsor claim fiduciary responsibility, assemble data used in making the denial determination, assemble, summarize and send to Plan Sponsor contact.-Research… more
- UCLA Health (Los Angeles, CA)
- …for accuracy, confirming the receipt of necessary documentation to support the denial and ensuring compliance with all contractual obligations and state and federal ... with them for clinical guidance in resolving cases. You will also document appeals in the tracking system and maintain relevant statistical data. Salary Range:… more
- Universal Health Services (Richmond, VA)
- …and closed denials to monitor trends at individual facility level to assist with denial avoidance, by providing feedback. + Assists Appeals Manager in providing ... United Kingdom. https://uhs.com/ The Atlantic Region CBO is seeking a dynamic and talented Appeals Team Lead. The Appeals Team Lead is responsible for working in… more
- Penn Medicine (Philadelphia, PA)
- …Confidentiality, and continuity of communication. + Supports the activities of the Clinical Appeals Coordinator in all phases of the Clinical Quality and ... of patient related information including the hospital database, reports and all denial and appeals correspondence. + Maintains database for the department… more
- CVS Health (Fresno, CA)
- …between 9am-1pm. Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Hartford HealthCare (Southington, CT)
- …of Connecticut's most comprehensive healthcare network as a Quality Improvement Coordinator . Hartford HealthCare at Home, the largest provider of homecare services ... clients and their clients' families. Basic Purpose of the Position: **Manages appeals at the branch level including clinical documentation review, training, and… more
- Rush University Medical Center (Chicago, IL)
- …* Provides designated support for functions including payer approval / certification communication, denial appeals , and / or level of care management processes. ... **Shift 1** **Work Schedule:** 8 Hr **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working with physicians, patients,… more
- Athena Health Care Systems (Seymour, CT)
- Resident Care Coordinator Assistant 7 am - 3 pm, Full-Time Shady Knoll Health Center - Seymour, CT Posted 1 month ago We are hiring a Resident Care Coordinator ... to grow within the company. As a Resident Care Coordinator Assistant, you will assist the Resident Care ...certifications and recertification. + Mails and tracks all Medicare denial letters. + Retrieves/prints and faxes medical records to… more
- Baystate Health (Springfield, MA)
- **Summary:** The Referral Authorization Coordinator is responsible for providing a variety of support services that are essential to the efficient operation of the ... insure proper payment for services provided. **4)** Consistently monitors and works denial and no referral reports to obtain prior authorizations and referrals.… more
- Hackensack Meridian Health (Neptune, NJ)
- …of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + ... and serve as a leader of positive change. The **Care Management, Care Coordinator , Utilization Management** is a member of the healthcare team and is responsible… more
- Hackensack Meridian Health (Hackensack, NJ)
- …of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews + ... and serve as a leader of positive change. The Case Management Care Coordinator , Utilization Management is a member of the healthcare team and is responsible… more
- Hackensack Meridian Health (Hackensack, NJ)
- …of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + ... and serve as a leader of positive change. The Case Management Care Coordinator , Utilization Management is a member of the healthcare team and is responsible… more
- Hackensack Meridian Health (Perth Amboy, NJ)
- …of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + ... and serve as a leader of positive change. The Care Management, Care Coordinator , Utilization Management is a member of the healthcare team and is responsible… more
- Hackensack Meridian Health (Manahawkin, NJ)
- …of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + ... serve as a leader of positive change. The Care Coordinator , Care Management is a member of the healthcare...**Responsibilities** A day in the life of a Care Coordinator ,Utilization Management at Hackensack Meridian Health includes: + Follows… more
- Hackensack Meridian Health (Edison, NJ)
- …of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. 2. ... **Overview** The Care Management, Care Coordinator , Utilization Management is a member of the...treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- BrightSpring Health Services (Columbus, OH)
- …Payee to Client Trust Fund* Responsible for working with Client Trust Fund Coordinator at the Austin* Business Center to set up RFMS Account* Assure individuals ... for each individual annually or as needed* Files Medicaid Appeals when required within 30-day time frame of decisions*...billing is complete for upload into Quickbase. Sends monthly Denial Reports to operations for any billing denied by… more