- 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 ... pre-certification required. Licensure Requirements: None. Apply/Share Job Title INSURANCE APPEALS SENIOR ID 4357425 Facility Covenant Health Corporate… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a Quality Control Senior Manager you want with your current employer? We have an exciting ... plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving… more
- GuideOne Insurance (Nashville, TN)
- As Senior Counsel, you will play a pivotal role in managing complex litigation and a broad range of legal matters within your state of licensure. In this ... depositions. + Prepares and drafts pre-trial motions. + Files or defends motion appeals . + Tries lawsuits. + Prepares and drafts post-trial motions. + Manages legal… more
- Elevance Health (Nashville, TN)
- …report reopenings. + Under guided supervision, participate in completing more complex appeals related work: + Position papers + Jurisdictional Reviews + Maintaining ... ability to travel may be required. **Audit & Reimbursement Senior ** **_Location: _** _This role enables associates to work...report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + PRRB… more
- BrightSpring Health Services (Nashville, TN)
- …include identifying reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolving billing-related issues. This position ... limited to billing, collections, cash posting, contract analysis, communications with insurance providers, and account management. Perform all end of month closing… more
- Centene Corporation (Nashville, TN)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point of ... Centene offers a comprehensive benefits package including: competitive pay, health insurance , 401K and stock purchase plans, tuition reimbursement, paid time off… more
- HCA Healthcare (Nashville, TN)
- …plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving ... assistance, pet insurance and more. + Free counseling services and resources...plan interpretation and administration. Analyze, research and present benefits appeals and recommendations. In addition, support employee benefits financial… more
- Evolent (Nashville, TN)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Nashville, TN)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Nashville, TN)
- …(NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals . + Ensures documentation of all communications with medical office staff ... overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in… more
- Evolent (Nashville, TN)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Guardian Life (Nashville, TN)
- …manage contracts and financial reimbursement rates with DSOs + Make presentations to senior -level management of DSOs + Identify and report to leadership team on ... for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams to resolve… more
- Evolent (Nashville, TN)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- Evolent (Nashville, TN)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more