- CVS Health (Harrisburg, PA)
- …between 9am-1pm. Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Oracle (Salem, OR)
- …us and grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to ... engineering for developing the Claim Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA)....necessity, level of care, clinical validation) to lead the appeals initiative to review denied claims, create write-ups for… more
- The Cigna Group (St. Louis, MO)
- …oversees State and Federal pharmacy reimbursement legislation and pharmacy appeals . Oversee business regulatory compliance projects and process enhancements. Monitor ... pertaining to State and Federal pricing, client specialty pricing, and pharmacy appeals . Responsible for providing Ad Hoc training, support and financial analysis of… more
- Molina Healthcare (Grand Rapids, MI)
- JOB DESCRIPTION Job Summary Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to ... and contractual guidelines. Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions.… more
- UnitedHealth Group (Minnetonka, MN)
- …difference? Join us to start Caring. Connecting. Growing together . The Senior Compliance Analyst for Flag Management is responsible for supporting provider-focused ... and implement solutions to address gaps in flagged provider workflows and appeals Communicate effectively with internal teams and external stakeholders through clear… more
- CVS Health (Oklahoma City, OK)
- …the way! This is a fulltime teleworker opportunity in Oklahoma. The Senior Claim Data Specialist handles end-to-end processes associated with claim data management. ... written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals . Ensures all compliance requirements are satisfied and that… more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. Summary : The Senior Employee Relations Consultant is responsible for mitigating organizational risk while ... updates or changes through the Policy Advisory Committee. Review and coordinate appeals and grievances services as applicable. Participate in the coordination and… more
- UTMB Health (Galveston, TX)
- …advice and guidance to managers regarding the employee grievance and appeals processes. Administers, interprets, communicates, and leads training regarding various ... human resources policies, procedures, federal and state employment laws, and initiatives that impact the work environment to management and employees. Serves as the employee relations expert to HR Business Partners and other HR colleagues. Mentors team members… more
- UnitedHealth Group (Minnetonka, MN)
- …of appeal process with knowledge how to speak to denial and/or appeals Provide documentation feedback to providers and query physicians when appropriate Provide ... education to new onboarding providers as well as continued education to all providers Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the Compliance, Coding Operations, etc Participate/Lead in coding department meetings… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …for assisting the entire Division with reaching financial goals. Reports to the Senior Director, Annual Giving, Direct Marketing (80%) and the Senior Assistant ... properly made. Upload electronic copies of all direct mail appeals to the DFCI Philanthropy network. Closely monitor and...refer to/inform supervisor as appropriate. Work with Direct Marketing Senior Director and Senior Assistant Director to… more
- Southland Industries (Horsham, PA)
- …the design team in all aspects of our work. What you'll do: Assist Senior Engineers in design tasks as required. Perform basic deliverables and products such as ... to heating, ventilating, and air-conditioning systems under supervision of Senior Engineers. Perform basic calculations for a project, such...one of the country's largest MEP building systems firms appeals to you and you're ready for the next… more
- Health Advocates Network (Phoenix, AZ)
- …and timely billing of services rendered Monitor claim denials, rejections, and appeals , and implement strategies to minimize claim errors and maximize clean claim ... and present revenue cycle performance reports, variance analyses, and recommendations to senior leadership and stakeholders Lead and develop the revenue cycle team,… more
- Southland Industries (Horsham, PA)
- …related to heating, ventilating, and air-conditioning systems under supervision of Senior Engineers. Performs basic calculations for a project, such as ... and potential career paths with one of the country's largest MEP building systems firms appeals to you and you're ready for the next big step in your career, then… more
- Guardian Life (Boston, MA)
- …manage contracts and financial reimbursement rates with DSOs Make presentations to senior -level management of DSOs Identify and report to leadership team on market ... for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams to resolve… more
- GE Aerospace (Cincinnati, OH)
- …Litigation & Investigations and interacting regularly with GE Aerospace senior executives. Responsibilities: Support the development and implementation of litigation ... international forums, including coordinating pleadings, discovery, motion practice, trials, appeals , and arbitrations. Provide counsel to stakeholders and cross-functional… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... insurance pre-certification required. Licensure Requirements: None. Apply/Share Job Title INSURANCE APPEALS SENIOR ID 4357425 Facility Covenant Health Corporate… more
- Centene Corporation (Jefferson City, MO)
- …medical directors and supervise MD's responsible for utilization management and appeals functions to ensure members receive medically necessary, evidence-based care ... the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy, case management, disease management, cost containment, and medical… more
- CVS Health (Austin, TX)
- …issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from ... outside plan sponsors or regulators. + Research and resolves incoming electronic appeals as appropriate as a "single-point-of-contact" based on type of appeal. +… more
- Oracle (Little Rock, AR)
- …us and grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to ... engineering for developing the Claim Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA)....necessity, level of care, clinical validation) to lead the appeals initiative to review denied claims, create write-ups for… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials and ... Collaborate with clinical staff and coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed records in the… more
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