- Element Science (San Francisco, CA)
- …to analyze reimbursement impacts on financial performance and support budgeting processes. Team Leadership:Build and lead a high-performing reimbursement and ... health company focused on developing solutions at the intersection of clinical -grade wearables, machine learning algorithms, and lifesaving therapies in order to… more
- 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
- Commonwealth Care Alliance (Boston, MA)
- …This Role is Important to Us:** **Position Summary:** Reporting to the Director of Appeals & Grievances, the Manager, Appeals & Grievances (A&G) Audit and ... Oversight is responsible for the oversight of Plan level appeals and grievances within the Appeals &...Doing:** **Essential Duties & Responsibilities:** + Effectively manage a team to ensure a positive team environment,… more
- Elevance Health (Costa Mesa, CA)
- …contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and clinical services, ... **Manager I - Grievances & Appeals - Provider Disputes** **Location** : This position...Skills, Capabilities and Experiences:** + Experience supervising a production-based team preferred. + Prior experience with healthcare insurance claims… more
- Elevance Health (Rancho Cordova, CA)
- …matter expert for appeals /grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting the resolution of ... **Nurse Appeals - Licensed RN Nurse** **Location:** This position...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (Los Angeles, CA)
- …matter expert for appeals /grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting the resolution of ... **Nurse Appeals (Quality) - California candidates only** **Location: This...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Humana (Columbus, OH)
- …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
- Genesis Healthcare (Philadelphia, PA)
- POSITION SUMMARY: Assists the denial management team by conducting a comprehensive analytical review of patient's medical records. Appeal Writer/ Reimbursement ... to be paid. RESPONSIBILITIES/ACCOUNTABILITIES: Reviews patient medical records; utilize clinical , regulatory knowledge and skills to provide convincing appeal… more
- Glens Falls Hospital (Glens Falls, NY)
- …MCC's and CC's for reimbursement. In collaboration with Hospital External Review Team (HERT) members, coordinates reviews and responds to internal and external ... but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to… more
- Catholic Health Services (Melville, NY)
- …time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! ... an operations' liaison, collaborating with various entities including payers, clinical , financial and/or operational departments. Duties/Responsibilities: Conducts data analysis… more
- CareFirst (Baltimore, MD)
- … clinical and diagnostic clinical operations strategy. The Vice President will lead and build a team of clinical operations professionals who oversee ... Case Management, Utilization Management including prior authorization, and post service clinical medical review and Appeals & Grievances operational functions… more
- Medical Mutual of Ohio (OH)
- …complex outpatient, inpatient and professional claim irregularities, overpayments and provider appeals from a clinical coding perspective, applying coding ... abnormalities, questionable billing practices and proper coding combinations from a clinical and coding perspective and documents denial reasoning or erroneous… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …encompasses a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations, enrollment, ... environment. This manager also has direct oversight to a team of clinical (RN) reviewers and offers...the Associate Director of FEP Operations. Key Accountabilities: + Lead and motivate a team by creating… more
- State of Colorado (Golden, CO)
- …of each fiscal year. Plans for and directs the professional development of the Clinical team , trains to relevant standards of policy and procedure, resolves ... population within the Department of Human Services, Division of Youth Services. Afford clinical expertise and feedback to mental health team members regarding… more
- CareOregon (Portland, OR)
- …collaboration in a CCO environment This position may be assigned to lead medical management, clinical informatics, behavioral health, and/or population health ... This position is responsible for leading a multidisciplinary, matrixed team in supporting both internal staff, as well as...clinical systems. + May plan, participate in, or lead CCO Clinical Advisory Panel (CAP), depending… more
- Kepro (AR)
- …the public sector. Acentra seeks a Dental Hygienist Reviewer to join our growing team . Summary Description The Dental Clinical Specialist is responsible for the ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...If a secondary review is necessary, such as denials, appeals , and fair hearings, the Dental Clinical … more
- Kepro (Lexington, NC)
- …a vital partner for health solutions in the public sector. Acentra Health seeks a Clinical Assessor to join our growing team . Job Summary: Acentra Health is ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra… more
- Trinity Health (Des Moines, IA)
- …Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in quality ... for Medicare and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with the hospital'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
- Healthfirst (NY)
- …+ Ability to lead large and small working meetings + Strong clinical writing, verbal, and presentation skills + PC Skills with Microsoft Word, PowerPoint ... **Duties & Responsibilities:** + Works collaboratively to oversee clinical operations of assigned pharmacy benefits + Provides clinical pharmacy support for the… more
