- 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:… more
- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications… more
- Community Health Systems (Franklin, TN)
- …Other duties may be assigned. + File medical necessity and level of care appeals using InterQual and CMS guidelines as needed. + Monitor clinical appeal ... guidance and feedback to related departments as needed. + Track and manage clinical denials using current tools (manuals, training programs). + Identify patterns and… more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Healthfirst (NY)
- …OR Dental Hygienist Preferred Qualifications: + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, ... and Responsibilities: + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... Medicare Managed Care Manuals + For USFHP Focused Specialist : + Researches, processes and resolves all appeals...providers and third-party administrators + Prepares case files on clinical member and provider appeals for review… 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 ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible for providing comprehensive responses in compliance with contract, regulatory and accreditation requirements ... an administrative clinical setting, including 1-2 years medicaid managed care appeals process & Health/Human Services. + The ability to effectively interact with… more
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop internal… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy… more
- University of Michigan (Ann Arbor, MI)
- Revenue Cycle Coding Supervisor - Appeals & Denials Apply Now **Job Summary** The Denial Coding Supervisor provides subject matter expertise in physician medical ... activities. This position oversees the Physician Billing (PB) Denial Coders and Appeals and Denial Coordinators, ensuring the accuracy and efficiency of denial… more
- Veterans Affairs, Veterans Health Administration (IN)
- …or in the District of Columbia. Grade Determinations: Occupational Therapist ( Clinical Specialist ), GS-13 Education, Experience, and Licensure. Completion of ... and resource and service linkage. Responsibilities The CSP is a clinical program that provides state-of-the-art continuum of services, education and resources… more
- Glens Falls Hospital (Glens Falls, NY)
- …but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to ... Emergency coding *Licenses, Certifications, Registrations* * o CCS, RHIT, RHIA, Certified Coding Specialist is Required o CDIP is a plus *Salary Range* The expected… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4770759) Apply Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction… more
- Point32Health (MA)
- …are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Training Specialist is responsible for the development, ... implementation, and execution of a wide range of clinical , regulatory and operational training programs, including orientation and annual competency. This individual… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist (Critical Care) performs other related duties as ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Insight Global (Skokie, IL)
- Job Description Insight Global is looking for a clinical denials specialist to join the team at one of your healthcare clients in Chicago. As a Clinical ... perspective. This person will be responsible for preparing appeals and communication with the clinical team members. With a strong focus on maximizing patient… more
- Robert Half Accountemps (Durham, NC)
- …medical policies and collaborate with Medical Directors for decisions regarding clinical appeals /grievances * Ensure quality, efficiency, and timeliness in ... Description We are in search of an Intake Specialist to join our team. This role is...the healthcare industry, specifically dealing with Medicare Advantage Member appeals from providers. The workplace is based in Durham,… more
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