- Blanchard Valley Health System (Findlay, OH)
- …of productivity to effectively reduce days in A/R. Develops and writes appeals for denials associated with the payment of claims within the department/division. ... Maintains appropriate timeliness of appeals for denials. Identifies other means and resources to...motion with intermittent bending, squatting, kneeling, and twisting. The associate must be able to sit for 3 hours,… more
- DivIHN Integration Inc (Livermore, CA)
- …websites. o Accurately document accounts collection notes. o Responsible for processing appeals and researching of claims. o Follow specific payer guidelines for ... appeals submission. o Prioritize and manage accounts to resolve...EDUCATION: o High school diploma or GED required o Associate degree preferred o Preferred years of experience -… more
- Penske Truck Leasing Co., LP (Reading, PA)
- …or manager with operating tax compliance processes including rendition/return filing, appeals and abatements and refund/bill entry. * Be able to understand ... or manager with operating tax compliance processes including rendition/return filing, appeals and abatements, bill entry for operating tax * Analyze processes,… more
- Compass Health Network (Sullivan, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... values diversity Nurse qualifications: * High School/GED degree required* Associate /Bachelor's degree in nursing preferred LICENSURE/CERTIFICATION: GPN, LPN, GN or… more
- CVS Health (Hartford, CT)
- …1+ years of Coding experience + Utilization Review experience + Medicare experience + Appeals experience Education + Associate RN Degree or RN Diploma required ... 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Hartford, CT)
- …Qualifications + Utilization Review experience + Medicare experience + Managed Care Appeals experience Education + Associate 's degree or RN diploma required ... designated time zone) with occasional weekends and holidays. The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Harrisburg, PA)
- …to make health care more personal, convenient and affordable. Position Summary The Associate Manager will assist in the hiring and managing of the Medicare ... Complaints Team staff. The Associate Manager must possess outstanding people skills, exercise good judgement, and contribute to a team environment. Ability to build… more
- Universal Health Services (Richmond, VA)
- …or equivalent, Associate 's degree or higher preferred + 3-5 years appeals experience preferred + Strong Microsoft Office skills (Excel, Word, Outlook) + Ability ... Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist. The Senior Appeals Specialist is responsible for the resolution of all … more
- Magellan Health Services (San Diego, CA)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...Education - Required GED, High School Education - Preferred Associate License and Certifications - Required License and Certifications… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Elevance Health (Cincinnati, OH)
- **Grievance/ Appeals Analyst Lead** **Must be located within 50 miles of a PulsePoint office** **This position is primarily work from home but requires working in a ... local office once per quarter** The **Grievance/ Appeals Analyst Lead** is responsible for leading and coaching a team of Grievance & Appeals Analysts in the… more
- Centene Corporation (Phoenix, AZ)
- …and scanning incoming mail **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- Centene Corporation (Raleigh, NC)
- …provide resolutions for grievances. **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , ... Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Friday, May 3, 2024 Centers Plan for Healthy Living's goal is to create ... healthy living. JOB SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- CVS Health (Hartford, CT)
- …with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare Part C appeals from both members and providers. This role is...+ Exceptional verbal and written communication skills Education + Associate 's Degree or RN diploma required Pay Range The… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician ... (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...least 3 years of experience in clinical setting. **Education:** Associate 's Degree in Nursing (ADN) required, Bachelor's of Science… more
- Humana (Columbus, OH)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
