- Chestnut Health Systems (Carlock, IL)
- …Cycle Representative (Billing) position is based in Normal, IL. Responsibilities Support agency management in billing and collections of accounts receivable. Review ... balances. Communicate with Utilization Review Coordinator regarding authorizations and appeals , documenting all communication in EHR. Respond to communication from… more
- Centene Corporation (Phoenix, AZ)
- …individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data entry, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Elevance Health (Columbus, OH)
- …Services to transform federal health programs. The **Audit and Reimbursement Senior- Appeals ** will support our Medicare Administrative Contract (MAC) with ... **Audit & Reimbursement Senior- Appeals ** _This is a United States based, virtual...and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …+ Advanced degree. + Minimum 1 year of professional experience in health care field, appeals , or LTC program support . + Minimum 1 year of professional experience ... OAAS LT-PCS Appeals - Coordinator 1 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4677715) OAAS LT-PCS Appeals - Coordinator 1 Salary… more
- CVS Health (Salem, OR)
- …Review nurses Provide after hours and weekend coverage on a rotational basis to support 24/7 appeals work * IRE monitoring and tracking and Utilization ... what we deliver. Our Heart At Work Behaviors (TM) support this purpose. We want everyone who works at...of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C … more
- UCLA Health (Los Angeles, CA)
- …of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals . Leverage your expertise to support UCLA Health's commitment to ... accuracy and quality in claim processing. As an Audit and Appeals Specialist, you will: + Facilitate responses to regulatory audits related to billing, coding, and… more
- Colorado State University (Fort Collins, CO)
- …Student Eligibility to coordinate completing all verification, data resolution, and professional judgment appeals + Provide support as necessary to all areas of ... as the primary resource for issues related to professional judgment appeals and provides timely support to office staff so that they may quickly and effectively… more
- IQVIA (Phoenix, AZ)
- …companies for benefit investigation and coverage eligibility + Provide prior authorizations and appeals support + Assist patients with the enrollment process for ... and/or providers to evaluate eligibility for assistance programs and/or varied adherence support . This is a **remote** position. **Hours:** **Must be available for… more
- Amentum (Washington, DC)
- …SMO team, Amentum leadership, and staff collaboratively Oversee and ensure operational support services are delivered to VCF Appeals /Hearings components and ... Deputy Special Master and DOJ Attorney Team Leads regarding Appeals /Hearings operations and/or issues. + Oversee and support... Appeals /Hearings operations and/or issues. + Oversee and support 2 Amentum Appeals /Hearings staff to ensure… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with local case ... management leadership. This individual will support the pursuit of excellence in care coordination, discharge planning, resource stewardship, and regulatory… more
- VNS Health (Manhattan, NY)
- …+ Ensures the accuracy and integrity of data collection and reporting systems to support analysis and reporting of grievances and appeals data for operations and ... Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance...(RN)to lead the daily operations of our grievance and appeals processes. You will play a crucial role in… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose....purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the… 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
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance/ Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... + **Costa Mesa** + **Palo Alto** + **Walnut Creek** The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- CareFirst (Baltimore, MD)
- …the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance departmental capabilities. Accountable… 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, ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Customer… 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, ... for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Customer… more
- Ally Pediatric Therapy (Chandler, AZ)
- …when necessary. - Collaborate with clinical staff to provide documentation supporting appeals . Patient & Family Support : - Assist families with understanding ... families to ensure accurate and timely billing, optimize revenue, and provide support to families navigating the complexities of insurance coverage for autism… more
- City of New York (New York, NY)
- …Center for Creative Conflict Resolution which provides mediation and restorative justice support to City government agencies and the general public, and the ... a resource center that provides training, continuing education, research and support services for administrative law judges and hearing officers. JOB DESCRIPTION:… more
- R1 RCM (Chicago, IL)
- …on clinical appeals and denials management. Every day you will support client hospitals where claims were denied or underpaid by governmental contractors, ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert… more
