- Elevance Health (Richmond, VA)
- **Title: Grievance/ Appeals Analyst II** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst II** will be responsible for...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Elevance Health (Richmond, VA)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level...medical management review activities which require the interpretation of clinical information. + The analyst may serve… more
- Elevance Health (Columbus, GA)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level...medical management review activities which require the interpretation of clinical information. + The analyst may serve… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures ... the listings of International Classification of Diseases, Ninth Revision; Clinical Modification (ICD-9-CM American Medical Association Current Procedural Terminology… more
- Catholic Health Services (Melville, NY)
- …operations' liaison, collaborating with various entities including payers, clinical , financial and/or operational departments. Duties/Responsibilities: Conducts data ... financial performance through the development of analytics (financial, operational and clinical ) and corrective action plans which improve process flows and… more
- Genesis Healthcare (Philadelphia, PA)
- …comprehensive analytical review of patient's medical records. Appeal Writer/ Reimbursement Analyst will write sound, sensible and factual arguments that clearly ... to be paid. RESPONSIBILITIES/ACCOUNTABILITIES: Reviews patient medical records; utilize clinical , regulatory knowledge and skills to provide convincing appeal… 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/4640675) Apply Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) -… more
- R1 RCM (Boise, ID)
- …you will be responsible for key operational functions to include charge capture, clinical billing, appeals and advanced third-party or government audits. Every ... include department level reconciliation. + Share trends related to billing and appeals from a clinical perspective, provide transformation recommendations with… more
- City and County of San Francisco (San Francisco, CA)
- …years of verifiable professional human resources experience, similar to 1241 Human Resources Analyst , in one or more of the following areas of activity: recruitment ... training. Substitutions: Additional qualifying work experience as a professional human resources analyst may be substituted for up to two years of the required… more
- University of Michigan (Ann Arbor, MI)
- Reimbursement Analyst Senior Apply Now **How to Apply** A cover letter is required for consideration for this position, and it should be attached as the first page ... to this position. **Job Summary** Michigan Medicine Finance is seeking a reimbursement analyst to provide support for cost report preparation, cost report appeals… more
- City and County of San Francisco (San Francisco, CA)
- …Team is responsible for designing, configuring, testing, implementing and training the clinical and financial aspects of the DPH Electronic Health Record. The ideal ... HIM program specifically, within the organization; + Collaborate with HIM, RC, clinical groups and operations in configuring, training and/or optimizing Epic EHR; +… more
- City and County of San Francisco (San Francisco, CA)
- …Application Teams are responsible for designing, implementing, testing, and supporting the clinical and financial aspects of the San Francisco Department of Public ... Health Record. This includes integration and interoperability with other third party clinical and financial systems and devices. The ideal candidate will have an… more
- The Cigna Group (Bloomfield, CT)
- …with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C + Ability to ... differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- Atrius Health (Chelmsford, MA)
- …for responding to payer claim audits including Medicare program, writing complex clinical medical necessity appeals , analysis of claims data and billing ... management support. Gathers, compiles and organizes claims and denial data. Researches clinical and payer informational material for clinical and business… more
- City and County of San Francisco (San Francisco, CA)
- …in this class for the duration of the eligible list. The 2119 Health Care Analyst works with clinical and non- clinical staff and personnel in evaluation ... evaluation committees on their evaluation activities. The 2119 Health Care Analyst may perform other duties as assigned/required. MINIMUM QUALIFICATIONS Education*:… more
- The Cigna Group (Bloomfield, CT)
- Nurse Case Management Lead Analyst -Nurse Clinician - Accredo Job Description Summary The Nurse Clinician - RN is responsible for reviewing escalated clinical ... department. Identify and track trends for analytics reporting to ensure clinical criteria program integrity. Maintain a professional and ethical behavior at… more
- University of Miami (Medley, FL)
- …Office has an exciting opportunity for a Full-Time Revenue Cycle Payer Relations Analyst to work Remote. The Revenue Cycle Payer Relations Analyst performs ... recommendations for optimal managed care reimbursement. The Revenue Cycle Payer Relations Analyst will also collaborate with internal staff to resolve issues related… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean claim submission and timely ... CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration with the Claim Editing Manager, Physician,… more
- Healthfirst (NJ)
- …as a subject matter expert to defend claims payment policy disputes and appeals + Reviews claims editing escalated provider disputes/ appeals and provides ... with other departments to improve compliance with coding conventions and clinical practice guidelines + Leads continuous improvement and quality initiatives to… more
- BrightSpring Health Services (Valdosta, GA)
- …balancing and reporting.* Maintain open communication with Billing Specialist, Cash Application Analyst and Operations.* Send cash transfer & check requests to the ... with State Billing Portal sites, preferred.* Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement preferred*… more