- Sanford Health (Sioux Falls, SD)
- …or regulatory review functions. Strong knowledge of CMS, Medicaid, ACA, and Commercial appeals and grievances regulations. **Benefits** Sanford Health offers an ... oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA,… more
- Humana (Lincoln, NE)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director ...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- CVS Health (Springfield, IL)
- …portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...(Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. - Medical Directors will… more
- Humana (Juneau, AK)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Carson City, NV)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CVS Health (Austin, TX)
- …of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy ... CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Robert Half Finance & Accounting (Carlisle, PA)
- Description We are looking for a dedicated Revenue Cycle Management Director to lead and manage all aspects of our client's revenue cycle operations. This position ... * Oversee the revenue cycle processes for Medicaid, Medicare, managed care, commercial payers, and sliding fee programs. * Establish and enforce billing policies… more
- AmeriHealth Caritas (Washington, DC)
- **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the Market President, with oversight of operation services delivered by the ;Healthy DC ... Plan and all relevant federal, state, and local regulatory requirements. The Director Operations Healthy DC Plan is accountable for ensuring the plan's operating… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver,… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to the Executive Officer of… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to the Executive Officer of… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to the Executive Officer of… more
- State of Colorado (Sterling, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Officers" and are eligible for increased PERA benefits. + Medical and dental health plans. + Short and long...purposes. Four (4) years of employment experience in a commercial , institutional or industrial setting (such as hospital, hotel,… more
- State of Colorado (Greeley, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... in public safety. Full benefits are provided. Apprentices will earn their Commercial Driver's License and the requirements to qualify for a Highway Maintenance… more
- University of Southern California (Alhambra, CA)
- …ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare, Medi-Cal, MAC, RAC, and commercial insurance companies -when there is refusal or rejection to honor ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier… more
- State of Colorado (Summit County, CO)
- …Colorado Code of Regulations (CCR) 801-1,State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and ... traveling public? Are you interested in obtaining a Colorado Commercial Driver's License Class A or B? If so,...keeping them safe. The State of Colorado offers competitive medical , dental and vision insurance, life and disability insurance,… more
- Sacramento County (Sacramento, CA)
- …Building Inspector series review construction plans, and/or inspects all residential, commercial , industrial buildings, and other structures in Sacramento County to ... duties which have included reviewing construction plans and inspecting residential, commercial , and/or industrial buildings to determine compliance with local, state… more
- State of Colorado (Durango, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... traveling public? Are you interested in obtaining a Colorado Commercial Driver's License Class A or B? If so,...keeping them safe. The State of Colorado offers competitive medical , dental and vision insurance, life and disability insurance,… more
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