- 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
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff , the Appeal ... Overview The Appeals Manager is responsible to assist in the...patterns and trends to prepare education programs for the staff on identified deficiencies to best respond to all… 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
- Mount Sinai Health System (New York, NY)
- …the pre appeals department and related vendors , including supervision of pre appeals nurses, and support staff . + Develop and implement pre appeals ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd...while controlling costs. The Director collaborates closely with medical staff , vendors, case management, and payers to secure payment… more
- Sanford Health (Sioux Falls, SD)
- … and grievances resolution. Oversee training and professional development programs for appeals and grievances staff to maintain expertise and regulatory ... oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA,… 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...all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M… 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...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… 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
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- State of Colorado (Denver, CO)
- DD Waiver Enrollment & Appeals Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5159953) Apply DD Waiver Enrollment & Appeals ... care and driving value for Colorado. We are looking for aDD Waiver Enrollment & Appeals Specialist to join our Office Of Community Living ! As part of the State… more
- Centene Corporation (Phoenix, AZ)
- …Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve all State inquires related to ... complaints, grievances and appeals . + Review and process member and provider grievances...as liaison between member, provider regulatory agencies and internal staff . + Correspond with key individuals regarding grievance and… more
- Elevance Health (Mason, OH)
- **Medical Director-Dermatology Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law. The **Medical Director-Dermatology Appeals ** is responsible for the review of appeals...of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- Ochsner Health (New Orleans, LA)
- …The Appeals Specialist is responsible for managing and resolving insurance claim denials and underpayments to ensure accurate reimbursement. This role involves ... experience with project related, multi-task responsibilities with a professional staff , experience prioritizing, organizing and coordinating multiple work assignments… more
- Humana (Lincoln, NE)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... and medical necessity. The Medical Director will collaborate with clinicians and support staff to provide Humana members with optimal value based care in accordance… more
- City of New York (New York, NY)
- …Trial Preparation Assistant Supervisor to oversee the duties and train the professional staff in the Appeals Bureau. Specific duties will include, but are ... distributing work to and supervising a team of professional staff who perform the following duties and performing those...- Maintaining a working knowledge of court rules and Appeals Bureau policies and helping the Bureau Chief implement… more
- Elevance Health (Tampa, FL)
- …for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to identify ... to providers regarding coding and fee schedule updates. + Trains customer service staff on system issues. + Works with providers contracting staff when… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all diagnosis ... MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive… more
- Fallon Health (Worcester, MA)
- …we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for ... 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
- State of Colorado (Denver, CO)
- Senior Staff Accountant Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5164739) Apply Senior Staff Accountant Supervisor ... Medical, dental, and vision plans * State paid life insurance policy * Choice of 2 retirement plans (defined...for the following services: + Making payments to clients, staff , providers, and other vendors and recording the corresponding… more