- Magellan Health Services (San Diego, CA)
- …ensuring documents meet standards and are accurate. General Job Information Title Appeals Coordinator Grade 19 Work Experience - Required Customer Service ... Coordinates appeals process as assigned, attends to risk management...requests. In some cases may be combined with Grievance Coordinator functions. + Maintains a caseload and monitors day… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Wednesday, June 5, 2024 Centers Plan for Healthy Living's goal is to ... SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related grievances and … more
- Robert Half Legal (Concord, CA)
- …healthcare reimbursement consulting firm is seeking a skilled Paralegal/Case Assistant to join their appeals team as an Appeals Coordinator on a contract to ... The successful candidate will play a critical role in supporting the appeals process with Medicare's Provider Reimbursement Review Board, ensuring an efficient and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals &… more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... appeals process for the THMA South hospitals. The Appeals and Utilization Management Coordinator ensures the delivery of effective and efficient patient care… more
- Centene Corporation (IA)
- …state of Iowa. **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other external type appeals . ... both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services… more
- Centene Corporation (Tempe, AZ)
- …Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve all State inquires related to ... complaints, grievances and appeals . * Review and process member and provider grievances...* Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies… more
- CVS Health (Columbus, OH)
- …health care more personal, convenient and affordable. Position SummaryCreated grievance and appeals cases in the G&A system and sends acknowledgement letters to ... members and providersRequired QualificationsData Entry SkillsPreferred QualificationsOrganized, ability to multi-task, Detail orientedEducationHigh Scholl Diploma or GED Pay Range The typical pay range for this role is: $17.00 - $28.45 This pay range… more
- Penn Medicine (Philadelphia, PA)
- …Confidentiality, and continuity of communication. + Supports the activities of the Clinical Appeals Coordinator in all phases of the Clinical Quality and ... work? **Summary:** Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the goals and… more
- CVS Health (Carson City, NV)
- …affordable. Position Summary Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require ... issues and report and recommend solutions. Research incoming Medicare Fast Track appeals to identify if appropriate for unit based upon published business… more
- Insight Global (Los Angeles, CA)
- …use by the examiners or Participant Services Representatives when necessary. * Assist Appeals Coordinator with preparation of Benefits Committee appeal cases. * ... Job Description The Claims Review Coordinator is responsible for the investigation, documentation and...with State/Federal law, rules, and guidelines. The Claims Review Coordinator will perform research and utilize extensive claims knowledge… more
- Crossroads Hospice & Palliative Care (Green, OH)
- …and backgrounds + Problem-solving skills to research and resolve discrepancies, denials, appeals , collections Billing Coordinator Schedule & Benefits: + Monday ... we can create lasting impacts that transcend medical treatment. Billing Coordinator Responsibilities: + Obtain referrals and pre-authorizations as required for… more
- TEKsystems (Tempe, AZ)
- Description: The Account & Appeals Coordinator is a support role, requiring the coordinator to assist the PNOA team by providing basic administrative and ... support functions in the team's day-to-day servicing of clients. The coordinator will participate in special projects as assigned by management and trainings with… more
- Apex Health Solutions (Houston, TX)
- …as part of the preauthorization process; flags cases for review by the Appeals & Outcomes Coordinator *Reports potential risk management cases or situations ... as needed for reporting, as maybe delegated by the Quality & Outcomes Coordinator . *Adheres to and apply all Health Solutions policies, procedures, and guidelines… more
- MyFlorida (Tallahassee, FL)
- …rules and regulations for the serious deficiency processes, complaint investigations and appeals . Serves as the division's alternate Rule Coordinator , alternate ... Coordinator , alternate Appeals Liaison, and alternate Forms Coordinator . Analyzes and interprets federal regulations, program trends and operational functions… more
- District of Columbia Courts (Washington, DC)
- Summary The Appeals Mediation Officer works within the District of Columbia Court of Appeals . As the highest court for the District of Columbia, the Court of ... Appeals is authorized to review all final orders, judgments... Mediation Officer, in consultation with the Mediation Program Coordinator , assists with the execution of mediations conducted under… more
- University of Utah (Salt Lake City, UT)
- …PRN38907B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt **Patient ... of revenue cycle. + Working knowledge of insurance denials, appeals and expected reimbursement rates. + Experience presenting findings...its regulations may be referred to the Title IX Coordinator , to the Department of Education, Office for Civil… more
- CVS Health (Harrisburg, PA)
- …personal, convenient and affordable. Position Summary The Medicare Grievance Sr. Coordinator will fully research and resolve beneficiary complaints. Candidates can ... live anywhere US These complaints can include various issues and may require coordination with various departments to fully reach resolution. Responses must be timely and include member focused solutions in both written and oral format. Ideal candidates will… more
- University of Virginia (Charlottesville, VA)
- …coding certification through AAPC. + Other duties as identified by Unit Coordinator , Supervisor and/or Manager. Position Compensation Range: $18.37 - $28.47 Hourly ... **MINIMUM REQUIREMENTS** Education: High School Diploma or GED Experience: Two years relevant office experience required. Experience in insurance field preferred. Experience utilizing EPIC or other medical billing system required. Licensure: CPC required or… more
- Ellis Medicine (Schenectady, NY)
- …the chart to fax or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of insurance authorizations ... and denials. + Denial Management Activities + Assists Denial Management staff with clerical support; including facilitating MD to MD reviews. + Performs audit activities under the supervision of the Director of Case Management and Social Work Services. more