- Catholic Health Services (Melville, NY)
- …named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... and/or escalates denial when appropriate. | Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. | Collaborates… more
- Guardian Life (Bethlehem, PA)
- Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The ** Appeals Case Manager II** (ACM 2) is ... responsible for adjudicating assigned appeals for Group Life and Disability claims. The ACM...Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals . You are A highly motivated and reliable individual… more
- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager ** , you will serve as an ... management. **Here's what you will experience working as a Clinical Appeals and Denials Manager ** + Responsible for the oversight of department supervisor(s) and… 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
- 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
- Elevance Health (Mason, OH)
- ** Manager II Grievance/ Appeals (RN)- Claims Support** **Location** : This position will work in a hybrid model (remote and office). Ideal candidates will live ... of our PulsePoint locations. Expected Work Hours: Monday-Friday; 8AM-5PM EST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of… more
- New York State Civil Service (Melville, 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 (Columbus, OH)
- ** Manager II Grievance/ Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within ... Health PulsePoint locations. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The ** Manager II Grievance/ Appeals ** is responsible for management oversight of… 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
- Elevance Health (Harrisburg, PA)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** _Elevance ... for Medicare and Medicaid Services to transform federal health programs. The **SCA Appeals Representative I** position is an entry-level position in the NGS … more
- Elevance Health (Palo Alto, 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...culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in… more
- Beth Israel Lahey Health (Charlestown, MA)
- …taking a job, you're making a difference in people's lives.** Reporting to the Manager , Patient Financial Services, the Clinical Analyst plays an important role 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… more
- Genesis Healthcare (Seven Fields, PA)
- …our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up of denied claims from ... based on the response from the payer and takes appropriate action, including appeals , based on the type of denial. Documents all necessary elements; reason for… 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
- Community Health Systems (Sarasota, FL)
- …Functions** + Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals and communicates daily with Sr. Director/ Manager on trends identified + ... (Full-Time, Remote) The Appeals Specialist I is responsible for reviewing patient...to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems, you'll play… more
- New York State Civil Service (Albany, NY)
- …Services, Department of Title Director of Health Complaints and External Appeals (Director Financial Services Programs 3, NS) Occupational Category Other ... candidates for the position of Director of Health Complaints and External Appeals in Consumer Protection and Financial Enforcement Division (CPFED). The incumbent of… 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 ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
Related Job Searches:
Appeals,
Appeals Correspondence Manager,
Appeals Grievance Manager,
Appeals Manager Department Utilization,
Case Manager Appeals,
Clinical Appeals Denials Manager,
Denials Appeals Manager,
Manager,
Manager Appeals Grievances,
Senior Manager Appeals Grievances