- Harbor Health Services, Inc. (Mattapan, MA)
- …comprehensive benefits package including Health, Dental, Vision, Life, & Disability insurance , 403b Savings Plan, Generous Paid Time Off plus 11 additional ... process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist, maintains oversight of the Grievances and … more
- Whitney M Young (Albany, NY)
- …benefits package including generous time off, affordable health, dental and vision insurance , 401k with safe harbor employer match, tuition reimbursement, term life ... insurance , and more! GENERAL RESPONSIBILITIES: Whitney Young Health &...this role assists in the strategy and execution of appeals , digital campaigns, phone-a-thons, and donor stewardship to meet… 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 ... integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim… more
- Point32Health (FL)
- …as a customer service or member services representative in health care or insurance + Preferred: 2 years' Appeals and Grievance experience **Skill Requirements** ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and...NCQA (National Committee for Quality Assurance), DOI (Dept of Insurance ), CMS, DOL and any state or federal specific… more
- Healthfirst (FL)
- …+ **Minimum of two (2) years of work experience in Managed Care Health Insurance Plan** + **Experience with appeals for Medicare, Medicaid, Dual enrollment and ... certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently:** + **Research… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …elections related to public collective bargaining. + Directing the process for non-unemployment insurance appeals and notifying parties of the issues to go ... IA Job Type Full-time Job Number 26-01603 Agency 427 Department of Inspections, Appeals & Licensing Opening Date 12/18/2025 Closing Date 12/28/2025 11:59 PM Central… more
- Beth Israel Lahey Health (Cambridge, MA)
- …writing skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer ... of care. Applies knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of care and risk management issues.… more
- Guthrie (Sayre, PA)
- …within the unit. Takes the necessary action to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing ... Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as...skills and proficiency in analyzing complex billing problems, prepares appeals , challenges payer policies and pursues appeal turnover when… more
- Robert Half Accountemps (Port Washington, NY)
- …role requires strong communication skills and the ability to handle complex insurance claims, appeals , and patient inquiries. Responsibilities: * Review denied ... medical claims and file appeals as needed. * Address patient inquiries regarding claim...needed. * Address patient inquiries regarding claim issues and insurance coverage with professionalism and clarity. * Billing and… more
- Robert Half Accountemps (French Camp, CA)
- …accurate information to managers, patients, and external agencies. * Process insurance claims, appeals , and treatment authorization forms while maintaining ... (DDE) and Epaces for data management. * Demonstrated ability to handle appeals and benefit functions in compliance with healthcare regulations. * Excellent… more
- Whidbey General Hospital (Coupeville, WA)
- …refunds, and audits. + Inputs statistically numbers in online reports. + Prepares insurance appeals and follows up as required. + Processes technical denials. ... responsible for coordinating patient referrals and subsequent follow up, verifying insurance and providing financial counseling to assist with self-pay accounts, as… more
- Sanford Health (Sioux Falls, SD)
- …oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA, ... ensures adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- University of Michigan (Ann Arbor, MI)
- …for both the inpatient and outpatient populations. They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will ... Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join...Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... who provides strategic leadership and operational oversight for the hospital's pre- appeals management program. This role ensures the appropriate use of medical… more
- Addiction Recovery Care (Lexington, KY)
- …and timely through defined communication and escalation channels. + Carry out insurance appeals + Resolves work assigned according to the prescribed ... is responsible for resolving outstanding claims with government and commercial health insurance payers submitted on behalf of Addiction Recovery Care in accordance… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Henry Ford Health System (Troy, MI)
- RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS - 40 HOURS WEEKLY - DAY SHIFT Full Time Benefit Eligible Schedule: Monday through Friday, 8:00AM to 4:30PM. ... Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse! We are...EXPERIENCE: + Prior Utilization review experience in a health insurance setting. + Prior inpatient nursing experience in a… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
