- HCA Healthcare (Nashville, TN)
- …year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Appeals Team Lead with Parallon you can be ... resources you need to succeed in our organization. We are looking for an enthusiastic Clinical Appeals Team Lead to help us reach our goals. Unlock your… more
- Humana (Nashville, TN)
- …member PHI / HIPAA information This is a remote position reporting to Grievance and Appeals Director or MD Team Lead **Scheduled Weekly Hours** 40 **Pay ... on medical background and reviews health claims and preservice appeals . The Corporate Medical Director reviews cases of diverse...case reviews, works under minimal supervision; and partners with clinical peers and leaders to meet team 's… more
- Vanderbilt University Medical Center (Nashville, TN)
- …level of knowledge within a professional area and working knowledge of other areas. Team Interaction: May lead mid-sized projects; coaches and guides team ... TVC General Neurology, and Green Hills MS clinics. This team member will be involved with direct patient care...coordinate infusion schedule requests, assisting with payor denials and appeals , and any other work necessary to initiate and… more
- LifePoint Health (Brentwood, TN)
- …hospital leadership. This position also provides oversight to the DRG Downgrade Appeals Specialist team . *Responsibilities:* . Oversee the operations and human ... to maintain and improve KPIs. . Develop and execute appeals management strategies for the DRG downgrade team...within the medical record and evidence-based literature. . Ensure appeals follow current industry clinical guidelines, evidence… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Kepro (Nashville, TN)
- …Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver ... maximum value and impact. Lead the Way is our rallying cry at Acentra...- making this a great time to join our team of passionate individuals dedicated to being a vital… more
- HCA Healthcare (Nashville, TN)
- …optimum patient experience. What you will do in this role: + You will lead clinical performance expectations that support the goals of consistent clinical ... consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge planning, case… more
- Humana (Nashville, TN)
- …resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- The Cigna Group (Franklin, TN)
- …the programs. **Responsibilities and Essential Functions** + Responsible for development of clinical policy, clinical review decisions, appeals , audits, and ... program development, clinical criteria, and provider issues, supported by program clinical leaders + Collaborate with the Analytics team to provide… more
- Humana (Nashville, TN)
- …and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, ... reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.… more
- CVS Health (Nashville, TN)
- …not included in the aligned plan's service array. + Serves as a key clinical lead in developing and implementing evidence-based clinical policies and ... appeals , policies and procedures, and responsible health care expenditure to improve clinical outcomes. They will help lead continued quality improvement and… more
- Humana (Nashville, TN)
- …some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and clinical leadership. After ... is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical ...performed with minimal direction, but with support from other team members. The Medical Director enjoys working in a… more
- Elevance Health (Spring Hill, TN)
- …those member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care ... + Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for… more
- Elevance Health (Nashville, TN)
- …of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. **How ... policies, reimbursement policies, and editing rules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support… more