- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager ** , you will serve as an ... denial management. **Here's what you will experience working as a Clinical Appeals & Denials Manager :** + Serve as a leader and mentor to Clinical 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 ... goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred **Experience:** 5 years' Experience in… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- Conduent (Hamilton, NJ)
- …and Health Services (DMAHS) of New Jersey. **Reports To** This position reports to the Appeals Supervisor and the Appeals Manager . The Appeals ... individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and...were denied coverage, or their coverage was terminated. Our Appeals Counselors process these appeals from applicants… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures… more
- New York State Civil Service (Liverpool, NY)
- …by the Workers' Compensation Law;* Assisting in the assignment of cases when the Appeals Unit Manager is absent for extended periods;* Assisting the Legal ... Attorney 2/ Assistant Attorney 3 / Senior Attorney - Appeals (NY HELPS) Occupational Category Legal Salary Grade NS...requests;* Preparing and timely filing clearly written and persuasive appeals , rebuttals, and memos of law with reference to… 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 ... + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The ** Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals… 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 contain multiple issues and, may require coordination… more
- Health First (Melbourne, FL)
- …Plans (Health Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** * Manager Complaints, Grievances, and Appeals * **Location:** *Florida - ... in the State of Florida* *POSITION SUMMARY* Manage the formal complaints and appeals process in a timely, professional and compliant manner, to include formal member… more
- CareFirst (Baltimore, MD)
- …educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the development and ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate...Licensure Upon Hire Required. + CCM - Certified Case Manager Upon Hire Preferred. + LNCC - Legal Nurse… more
- Children's Home Healthcare (Richardson, TX)
- …(This is not a remote position) Billing Assistant Essential Functions: + Assist Billing Manager and Appeals Manager with billing operations of agency on ... no claims are filed outside to the timely filing deadlines. + Assist appeals manager with daily appeals and appeal projects. Billing Assistant Financial and… more
- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator, Senior position, is focused on the processing of customer and provider Medicare and Commercial appeals and ... incoming complaints, process medical necessity, utilization management and claims appeals , initiate Independent Review Organization external reviews as well as… 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...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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 ... all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group...Education Consultant works with the PSG Central Coding Support Manager and team to improve the accuracy, integrity and… 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
- 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...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- Elevance Health (Columbus, OH)
- **Audit & Reimbursement Senior- Appeals ** _This is a United States based, virtual position._ **National Government Services** is a proud member of Elevance Health's ... Services to transform federal health programs. The **Audit and Reimbursement Senior- Appeals ** will support our Medicare Administrative Contract (MAC) with the… more
- Mount Sinai Health System (New York, NY)
- **Job Description** This position serves as Appeals Analyst for Central Billing Office management. Responsible for monitoring contractual allowances, analyzing and ... pursuing appeals opportunities with payors and networks, and reporting performance...and analyzes data in our contract compliance tool (Contract Manager ), EPIC, and payor policy detail for identified payment… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and defend… more