- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role The Appeals Manager is responsible managing Appeal Supervisors and identifying opportunities for enhancements and changes to workflows to increase ... + Effectively manage Appeal Supervisors, providing full-time support to appeals , internal departments, vendors, and customers. + Demonstrate strong leadership… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging… more
- Covenant Health Inc. (Knoxville, TN)
- …appeals hand-offs, maintaining payer correspondence and claims processing. + Notifies Appeals Supervisor or Revenue Integrity Manager when trends are ... Overview Insurance Appeals Associate Full Time, 80 Hours Per Pay...follow-up with regard to clinical and medical necessity insurance appeals . Analyzes all correspondence regarding insurance denials for the… more
- Covenant Health Inc. (Knoxville, TN)
- …appeals hand-offs, maintaining payer correspondence and claims processing. + Notifies Appeals Supervisor or Revenue Integrity Manager when trends are ... Overview Insurance Appeals Associate Full Time, 80 Hours Per Pay...by the department established policies and procedures under the Manager and Supervisor within the department. It requires knowledge… more
- CVS Health (Richmond, VA)
- …Understanding of current Aetna healthcare systems and products including but not limited to HRP, GPS, ATV, MedCompass, Pharmacy systems, etc.-Experience working in a ... fast paced collaborative team environment while delivering a quality product.Prior management experience preferred but not required Preferred Qualifications Prior management experience preferred but not required Understanding of Complaint and Appeal Policies… more
- Centene Corporation (Austin, TX)
- …on workplace flexibility. **Position Purpose:** Manages the denials and/or appeals , disputes, and reconsiderations process including the drafting and review ... of NCQA and state Medicaid program requirements preferred. Advanced knowledge of appeals process preferred. Pay Range: $72,400.00 - $130,100.00 per year Centene… more
- CVS Health (Harrisburg, PA)
- …make health care more personal, convenient and affordable. Position Summary The Associate Manager will assist in the hiring and managing of the Medicare Complaints ... Team staff. The Associate Manager must possess outstanding people skills, exercise good judgement, and contribute to a team environment. Ability to build positive… more
- Actalent (Sacramento, CA)
- …denial. + The Medi-Cal Appeals and Grievances senior RN will report to the Appeals and Grievances Manager . + In this role, you will perform accurate and ... Description: + The Medi-Cal Member Appeals and Grievances team is responsible for clinically...and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either… more
- Universal Health Services (Richmond, VA)
- …The Nurse Auditor Team Lead is responsible for working in conjunction with the Appeals Manager to coordinate the operational activities of the nurse auditor's ... workflow in the Appeals department. Key Responsibilities include: + Completes training of...weekly and monthly reports as assigned. + Assist department manager and assistant director with developing individual and group… more
- Hawaiian Electric (Honolulu, HI)
- …on all aspects of litigation matters from case inception to judgment and appeals . Role: Manager Number of Vacancies:1 Work Schedule:Monday - Friday Work ... available. This position may be filled on Oahu or Kahului, Maui. (Role: Manager ) JOB FUNCTION: Provide in-house legal services, with an emphasis on public utility… more
- Trinity Health (Farmington Hills, MI)
- …Position (Pay Range: $39.8218-$59.7327) Applies clinical and comprehensive payer and appeals knowledge in reviewing all post-billed denials (inclusive of clinical ... of claim escalations. Responsible for leveraging clinical and broad payer and appeals knowledge, and standard procedures to track appeals through first,… more
- Fallon Health (Worcester, MA)
- …purpose** : Responsible for the coordination and timely completion of provider appeals . Serves as a liaison between Fallon Health and contracted and non-contracted ... providers with appeals regarding filing limit appeals , claim denials,...calendar or at the direction of a supervisor or manager . **Qualifications** **Education** Bachelor's degree or equivalent combination of… more
- Lumen (Columbus, OH)
- …in partnering closely with the business leadership in Income Tax Audit and Appeals within Lumen? Does working in a fast-paced environment with agility sound ... exciting? We are seeking a Senior Tax Manager to lead all of our income tax audit...lead all of our income tax audit defense and appeals . This professional will champion our tax controversy related… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...assisting the Appeal and Grievances Compliance, Training and QA Manager to develop a successful and cohesive unit with… 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... position reports to the Clinical Program Manager . This job description is not designed to cover...active and unrestricted licensure throughout employment. + Understanding of Appeals guidelines as applicable with URAC, NCQA, and ERISA.… 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
- UNC Health Care (Chapel Hill, NC)
- …we serve. RN Utilization Manager position specifically for a Utilization Manager /Clinical Appeals Nurse. This person is based at the Hedrick building ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure… more
- University of Virginia (Charlottesville, VA)
- …+ Other duties as identified by Unit Coordinator, Supervisor and/or Manager . Position Compensation Range: $18.37 - $28.47 Hourly **MINIMUM REQUIREMENTS** Education: ... High School Diploma or GED Experience: Two years relevant office experience required. Experience in insurance field preferred. Experience utilizing EPIC or other medical billing system required. Licensure: CPC required or two years of insurance follow-up… more
- Pacific Medical Centers (Seattle, WA)
- …appeals for presentation. Decision maker for all post service, network and benefit appeals . Acts as second level manager for grievances. Works with patients ... presentation. Decision maker for all post-services, network and benefit appeals . Acts as second-level manager for grievances....network and benefit appeals . Acts as second-level manager for grievances. Works with patients or vendors to… more
Related Job Searches:
Appeals,
Appeals Correspondence Manager,
Appeals Grievance Manager,
Case Manager Appeals,
Denials Appeals Manager,
Manager,
Manager Appeals Grievances,
Senior Manager Appeals Grievances