- Chestnut Health Systems (Carlock, IL)
- …balances. Communicate with Utilization Review Coordinator regarding authorizations and appeals , documenting all communication in EHR. Respond to communication from ... assigned payers. Maintain an organized filing system . Function as a team member, supporting other team members as necessary. Qualifications Position requires a high… 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
- 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 ... * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or… more
- Mount Sinai Health System (New York, NY)
- …:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight ... **Job Description** This position serves as Appeals Analyst for Central Billing Office management. Responsible...**About Us** **Strength Through Diversity** The Mount Sinai Health System believes that diversity, equity, and inclusion are key… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate...serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- OAAS LT-PCS Appeals - Coordinator 1 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4677715) OAAS LT-PCS Appeals - Coordinator 1 Salary ... + Description + Benefits Minimum Qualifications Please clickHERE (https://ulsuno.wd1.myworkdayjobs.com/en-US/UniversityOfNewOrleans/job/Baton-Rouge-La/OAAS-LT-PCS- Appeals Coordinator-1\_R-001522-1?q=oaas) to apply. + Receive appeal notices… more
- Point32Health (VA)
- …(https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily...to effectuation and final case documentation in the A&G system of record. Work with Utilization Management and PNO… more
- CareFirst (Baltimore, MD)
- …+ Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used ... NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an...goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance… more
- R1 RCM (Chicago, IL)
- …solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the ... AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as...skills, experience, and relevant education or training. The healthcare system is always evolving - and it's up to… 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...in the proficient use of PC and UVA software systems to ensure that all + pre-certification/pre-authorization or appeal… more
- Medical Mutual of Ohio (Brooklyn, OH)
- … to the independent review entity (IRE) . Documents IRE responses on applicable systems . . Serves as a resource/training for appeals and grievances unit staff ... related to member and provider appeal issues, including identifying needed system changes and contacting other areas to implement those changes. **Responsibilities**… more
- City of New York (New York, NY)
- …services for administrative law judges and hearing officers. JOB DESCRIPTION: The OATH Appeals Division seeks an experienced attorney to serve as a full-time ... Appeals Officer. The Appeals Division reviews appeal...entering and updating data in case management databases and systems . - Preparing letters and memoranda relating to the… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...and certain positions in the Emergency Department). Alameda Health System is an equal opportunity employer and does not… more
- CVS Health (Salem, OR)
- …opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their ... of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C ...more years of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry *… more
- Mount Sinai Health System (New York, NY)
- …:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight ... or medical office experience required , 416 - HSO Appeals Management - MSH, Mount Sinai Hospital **Responsibilities** 1....May assist in processing payroll and/or maintaining the PTO system for the department. 13. May track expiration dates… 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
- 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...requirements. Serves as a super-user on electronic programs and systems used by the department. Assists in the development… more
- Mount Sinai Health System (New York, NY)
- …:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight ... + 4+ years related administrative or business experience , 416 - HSO Appeals Management - MSH, Mount Sinai Hospital **Responsibilities** (in order of importance… more
- Generac Power Systems (Waukesha, WI)
- …solutions company, we continue to push new boundaries. **Job Description:** The ** Appeals and Grievances Coordinator** is a critical team player who is responsible ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** + Perform a variety of… more
