- 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
- 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, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… 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 (Atlanta, GA)
- …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
- 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