- Prime Therapeutics (Trenton, NJ)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Appeals Coordinator **Job Description** + Maintains a caseload and monitors day to ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...into a database. + Prepares and presents information on appeals to panels second-level multi-disciplinary committee. + Participates in… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management, Care Coordinator , Utilization Management** is a member of the healthcare team and is responsible ... the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage length of… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management** is a member of the healthcare team and is responsible ... the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage length of… more
- Cardinal Health (Trenton, NJ)
- …to Cardinal Health_** The Sr. Coord, Individualized Care (Reimbursement Coordinator ) supports patient access to therapy through Reimbursement Support Services ... * Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- Cardinal Health (Trenton, NJ)
- …documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Knowledge of Medicare, Medicaid and Commercially insured ... payer common practices and policies, preferred + Critical and creative thinking, preferred + Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred + Knowledge of Medical/Pharmacy billing and coding is preferred + Important to… more
- Cardinal Health (Trenton, NJ)
- …Events and follow process for timely submission. Review all requests for appeals and ensure supporting documentation is present. Support team with call overflow ... when needed. Ability to mediate situations in which parties are in disagreement and facilitate a positive outcome. Effectively be able to multitask daily tasks and workload. + **TRAINING AND WORK SCHEDULES** : Your new hire training will take place… more
- Hackensack Meridian Health (Neptune, NJ)
- …of Care & Utilization Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling. This position is based out ... to requests and inquiries and provides information as requested. + Prepares required Appeals and Denial information for processing and follows up on receipt of… more
- NJM Insurance (Trenton, NJ)
- …to the Medical Management Administrator and Medical Services, the Precert Coordinator supports our Workers Compensation and Auto (PIP/Medpay) lines of business ... (ODG and/or MCG). + Conduct second level review of PIP Post-Service/Payment Appeals to assess prior determination and new records, including treatment, Independent… more