- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for ... the activities and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of business. We are looking… more
- University of Michigan (Ann Arbor, MI)
- Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and ... knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain compliance… 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
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los ... to achieve that purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the development of a successful… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating ... clinical and medical coding skills to review provider claim appeals for medical necessity, appropriate coding, and pricing of...and that work/life balance is a key part of associate wellbeing. For more information on how we work… 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
- 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 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Humana (Columbus, OH)
- …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
- Beth Israel Lahey Health (Charlestown, MA)
- …in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high level clinical ... gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in order to prove...or finance field . In the absence of an Associate 's Degree, an additional 4 years of healthcare revenue… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist II is responsible for follow-up of all appeals submitted. This individual manages denial/appeal correspondence and ... Tracker. Quality work is imperative for the department to run efficiently. As an Appeals Specialist II at Community Health Systems, you'll play a vital role in… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist I is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following ... financial service units to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems, you'll play a vital role in… more
- TEKsystems (Annapolis, MD)
- Hybrid Coding Appeals Analyst Opportunity to join one of Maryland's most renowned and established healthcare systems. This organization is committed to excellence in ... Schedule : Monday - Friday (Normal Business Hours) Position Summary: As a Coding Appeals Specialist, you will be a crucial member of the denial management team by… more
- Generac Power Systems (Waukesha, WI)
- …solutions company, we continue to push new boundaries. **Job Summary:** The ** Appeals and Grievances Specialist** 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:** Case Resolution + Handles… more
- City of New York (New York, NY)
- …Attorney is seeking two Attorney Assistants (TPA 1) to assist Appeals Bureau Assistant District Attorneys with post-conviction matters. JOB RESPONSIBILITIES: - ... motions, subpoenas, and other legal documents. - Maintain various Appeals Bureau databases and calendars. - All other duties...- High school diploma or GED required; bachelor's or associate degree preferred. - A valid New York State… more
- R1 RCM (Chicago, IL)
- The Follow up Associate II/ Appeals Specialist will be responsible for investigating and examining denial accounts, will apply appropriate methods and techniques ... went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply… more
- Humana (Columbus, OH)
- …(collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart ... healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal… more
- City of New York (New York, NY)
- …which the Board has a short window of time to issue a determination. The Associate will assist the Director of Appeals with handling visit restriction complaints ... guarantee an interview. Only candidates under consideration will be contacted. The Legal Associate (" Associate ") will report directly to, and work under the… more
- Harvard University (Cambridge, MA)
- …Office Location:USA - MA - Boston Business Title: Associate Director, Development CommunicationsSub-Unit: Salary Grade (https://hr.harvard.edu/salary-ranges#ranges) ... Position Description:Reporting to the director of Development Communications, the associate director will be responsible for HBS's alumni-focused direct marketing… more
- Community Health Systems (Sarasota, FL)
- …to six years related experience. Previous healthcare financial services experience or appeals /denials experience + Education: Nursing Degree ( Associate or ... triage, determine payment viability; and draft and submit credibly defensible appeals (according to payer guidelines) to obtain appropriate reimbursement for care… more