- Guidehouse (Birmingham, AL)
- …to Insurance Companies to resolve claim denials and account balances. + Performing Non- Clinical Appeals . + Assisting Supervisor /Manager as needed with ... various projects. + Escalate payer issues/trends to a supervisor with the appropriate information or take appropriate action...+ 0-2 years medical provider experience working with UB04, appeals & denials. **What Would Be Nice to Have**… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Job Summary** As the Supervisor , Appeals and Grievances you will oversee daily operations, staffing, and performance for a remote team of 15 Appeals & ... Pennsylvania Medicaid business. This role ensures that all provider appeals and grievance cases are processed accurately, timely, and...of 3 years of experience leading a team of clinical and non clinical staff + Minimum… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical...achieve regulatory standards. Acts as a back-up to the Supervisor in leading meetings and handling escalations as required.… more
- Corewell Health (Grand Rapids, MI)
- This position will support our non-contracted provider post claim appeals submitted to the health plan. Job Summary Responsible for the analysis, research and ... State and Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of… more
- Whitney Young Health Center (Albany, NY)
- Clinical Supervisor - Substance Use Disorder Programs (LCSW/LMSW/LMHC) (Req 101020) Albany, NY ... reimbursement, term life insurance, commuter benefits and more! GENERAL RESPONSIBILITIES: The Clinical Supervisor -SUD serves as a member of the Integrated… more
- City and County of San Francisco (San Francisco, CA)
- …choosing a job with purpose. Under general direction, the Medical Social Work Supervisor works for the Department Disability and Aging Services (DAS) Hub. This ... and Class 2940 Protective Services Worker staff. Along with supervision, this supervisor provides consultation concerning the most difficult cases and serves as… more
- State of Colorado (Sterling, CO)
- CDOC Social Worker/Counselor IV-Mental Health Supervisor - (STERLING) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5188711) Apply CDOC ... Social Worker/Counselor IV-Mental Health Supervisor - (STERLING) Salary $7,229.00 - $10,121.00 Monthly Location...leadership, supervision, oversight and vision for the mental health clinical program. This position is responsible for, but not… more
- State of Colorado (Canon City, CO)
- …for a smaller clinic, a shift within a larger complex facility, or a supervisor in a specialized clinical treatment unit. This position may be required ... DOC Nurse Supervisor - Canon City Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5180320) Apply DOC Nurse Supervisor - Canon City Salary… more
- Ventura County (Ventura, CA)
- Certified Coding Supervisor - Health Information Management Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4892159) Apply Certified Coding ... Supervisor - Health Information Management Salary $98,275.48 - $137,599.19...Information Management (HIM) department related to coding and CDI ( clinical documentation improvement). The ideal candidate will have a… more
- State of Colorado (Pueblo, CO)
- Clinical Safety Specialist II - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5197179) Apply Clinical Safety Specialist II - ... listed. + Description + Benefits + Questions Department Information Clinical Safety Specialist II - Full Time CMHHIP This...+ This position is responsible for working with the supervisor to ensure all services provided on the assigned… more
- Modivcare (AR)
- …may be the right fit for you! Modivcare is looking for an experienced Supervisor - Success & Investigative Services to join our team. This role is responsible ... data. + Participates in call quality calibration meetings and appeals processes. + Oversees complaint and call quality processes,...of experience, including 1-3 years of call center and/or clinical leadership experience. + Up to one (1) plus… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... Cancer Institute and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing… more
- Select Medical (Harrisburg, PA)
- **Overview** **Hospital Name: Central PA Neuro Transitional Center** **Position:** ** Clinical Liaison (RN, OT, PT, or SLP)** **Location: Harrisburg, PA** **Schedule: ... Full-time, M-F 8am - 5pm** ** Clinical Liaison (RN, OT, PT, or SLP)** **Competitive base...Obtaining insurance approvals and authorizations, as well as facilitating appeals for patients + Demonstrates positive referrer satisfaction and… more
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - ... Clinical Specialist - Pueblo Regional Center Salary $3,863.20 -...nurse as needed. This position exists as a unit supervisor who is responsible for supervising and coordinating shift… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- University of Washington (Seattle, WA)
- …and experiential offerings. The University of Washington School of Law's Clinical Program provides students with real-world legal experience assisting clients and ... for academic credit supervised by experienced faculty members. The Clinical law program currently has 10 in-house clinics (https://www.law.uw.edu/academics/experiential-learning/clinics)… more
- Corewell Health (Grand Rapids, MI)
- …State and Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- State of Colorado (Denver, CO)
- …staff by overseeing, providing, and coordinating all medically related care and clinical analyses necessary for the proper evaluation and treatment of the hospital's ... therapy needs of our patients. Other duties include: Primary Job Duties Clinical Physical Therapy: + Provides advanced clinical physical therapy services,… more
- University of Southern California (Los Angeles, CA)
- …denials, triage denied claims to distinguish coding-related denials versus clinical -related denials, evaluating claims deemed inappropriately paid by the ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...Specialists in order to acquire or clarify the necessary clinical documentation needed to facilitate accurate and complete coding,… more
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