- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials and … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- CVS Health (Frankfort, KY)
- …Summary** Coordinate effective resolution of member and/or provider/practitioner appeals , complaints and grievances. Responsible for the day-to-day management ... of staff to ensure effective resolution of member or provider/practitioner appeals , complaints and grievances for all products, which may contain multiple issues… more
- State of Massachusetts (Boston, MA)
- …deliver program integrity. What you'd do The Review Examiner I, who reports to the Appeals Manager , is based in Boston, MA**and is responsible for the following: ... is looking for an organized and independent self-starter to facilitate the appeals process through research, analysis, and investigation. The Review Examiner I is… more
- FirstEnergy (Akron, OH)
- …automation or AI where appropriate), strengthen controls and procedures, and handle audits and appeals . The Manager will report to the Director, Tax Planning and ... with FirstEnergy Service Company, a subsidiary of FirstEnergy Corp. The Manager , General Taxes, is responsible for compliance, accounting, forecasting, and planning… more
- Hawaiian Electric (Honolulu, HI)
- …working on all aspects of litigation matters from case inception to judgment and appeals . Role: Manager Number of Vacancies: 1 Location: Honolulu - Oahu Hiring ... LEGAL Division at Hawaiian Electric Company has 1 Management vacancy available. (Role: Manager ) This posting seeks to fill at either the Associate General Counsel or… more
- Garnet Health (Middletown, NY)
- …for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, policies and ... Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials is responsible… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager , Nursing positions are required ... HEALTH FACILITIES PROGRAM MANAGER , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4626091) Apply HEALTH FACILITIES PROGRAM MANAGER… more
- Elevance Health (FL)
- **Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, with ... and is dependent on court hearing schedules. The **Nurse Appeals - Litigation & Legal Support** is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- University of Washington (Seattle, WA)
- …Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote ... + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services in accordance with… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... required by law. Alternate locations may be considered. The ** Appeals Medical Director** is responsible for the appeal reviews...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/ Manager as needed with various projects. + ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...+ 0-2 years medical provider experience working with UB04, appeals & denials. **What Would Be Nice to Have**… more
- Elevance Health (Tampa, FL)
- …for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to identify ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Hildebrand Self-Help Center (Cambridge, MA)
- …and previous year's performance; + Determine ask string formulas and upgrade strategies for appeals ; + Work with the CEO and Manager of Institutional Giving to ... The Individual Giving Manager will join one of the largest providers...analyze, and cultivate donor relationships. What You Will Do: Appeals & Individual Fundraising + Grow and manage a… more
- Helio Health Inc. (Syracuse, NY)
- …when a question or concern arises. + Communicates insurance trends and unresolved appeals to the billing manager for further action. + Demonstrates adaptability ... files necessary for research and documentation. + Researches open claims and processes appeals when necessary. Follows up on patient and insurance company issues in… more
- NTT America, Inc. (Plano, TX)
- …and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a **Medicare ... Appeals Clinical Leader** to lead service delivery engagements and...service delivery engagements and improve end-to-end delivery of Medicare Appeals . Desire experience specifically for processes for clinical … more
- City and County of San Francisco (San Francisco, CA)
- …managed by a team headquartered in Millbrae consisting of a division manager and 5 section managers overseeing its business operations, distribution, engineering, ... direction of the Water Supply and Treatment Division (WSTD) Manager , the WSTD Maintenance Manager directs the...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- City and County of San Francisco (San Francisco, CA)
- …a key strategic leader, the Chief Information Security Officer (CISO) (0933 Manager V) will be responsible for developing and executing a comprehensive information ... Information Officer (CIO). The Chief Information Security Officer (0933 Manager V) performs the following essential job functions: +...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals , and audit processes within the ... of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists, coordinates with internal departments, and… more