- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for ... serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of...legal proceedings and provide testimony on behalf of the company . + Responsible for development and oversight of the… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...at 30 days of paid time off and 9 company holidays + Health insurance plan for you and… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare...at 30 days of paid time off and 9 company holidays + Health insurance plan for you and… more
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance/ Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- CareFirst (Baltimore, MD)
- …and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance departmental capabilities. Accountable… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- R1 RCM (Chicago, IL)
- …financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert on… more
- Elevance Health (Mason, OH)
- …Elevance Health location. **Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to grievances and ... appeals , manages inventory and production levels, and operational and...overall QI program and meet regulatory compliance/accreditation and the company standards. + Hires, trains, coaches, counsels, and evaluates… more
- CVS Health (Salem, OR)
- …health care more personal, convenient and affordable. **Position Summary** Aetna, a CVS Health Company , a Fortune 6 company , is one of the oldest and largest ... of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C ...This position also includes an award target in the company 's equity award program. In addition to your compensation,… more
- Elevance Health (Los Angeles, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The **Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal ... appropriate area for review. . Facilitates processing of Medicare appeals to the independent review entity (IRE) . Documents...and Compensation: + Employee bonus program. + 401(k) with company match up to 4% and an additional … more
- HCA Healthcare (Nashville, TN)
- **Description** **Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient and effective ... and delivery of all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group (PSG). The education… more
- University of Virginia (Haymarket, VA)
- …+ Follow the appropriate payor procedures for initiating reviews, reconsiderations and/or appeals . + Follow-up with the payors to assure our requests are responded ... to document root causes, reflect current status within the appeals process to assure our internal customers know at...demographics is compiled and communicated to the patients' insurance company in a timely and organized fashion. Using independent… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you have the career opportunities as an Payer Specialization Appeals Collector you want with your current employer? We have an exciting ... Do you want to work as an Payer Specialization Appeals Collector where your passion for creating positive patient...an equal opportunity employer and value diversity at our company . We do not discriminate on the basis of… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all...Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified… more
- Conduent (Hamilton, NJ)
- …a culture where individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and Full Benefits **Location ... an opportunity to make a real impact in a company that appreciates ideas and new ways of thinking?...were denied coverage, or their coverage was terminated. Our Appeals Counselors process these appeals from applicants… more
- CVS Health (Olympia, WA)
- …the United States. Manage the effective resolution of Medicare Participating Provider Appeals & Complaints. Responsible for the day-to-day management of staff to ... ensure effective resolution of provider appeals and complaints for Medicare Participating Providers, which may...into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and… more
- R1 RCM (Boise, ID)
- …performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse** , you will help our hospital clients by serving as… more
- Humana (Indianapolis, IN)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- State of Indiana (Indianapolis, IN)
- Governor's Summer Intern - DWD Appeals Date Posted: Nov 25, 2024 Requisition ID: 452807 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... Indiana Department of Workforce Development (DWD) is seeking an Appeals Intern to join our agency in the summer...join our agency in the summer of 2025. DWD's Appeals Division is responsible for conducting unemployment insurance, liability,… more