- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Boston, MA)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Fallon Health (Worcester, MA)
- …we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for ... Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Fallon Health Appeals and Grievance process is an essential function to Fallon Health's compliance… more
- Beth Israel Lahey Health (Cambridge, MA)
- …writing skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer ... work effectively with a variety of individuals, including physicians, administrators, nurse managers, outside regulatory organizations, insurance companies, and… more
- Commonwealth Care Alliance (Boston, MA)
- …intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary team for medical ... needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly...as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding ... pleasant, professional and cooperative demeanor with patients, physicians, colleagues and insurance companies + Knowledge of government and insurance company… more
- Beth Israel Lahey Health (Plymouth, MA)
- …team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding ... pleasant, professional and cooperative demeanor with patients, physicians, colleagues and insurance companies + Knowledge of government and insurance company… more
- Beth Israel Lahey Health (Newburyport, MA)
- …mailing, in collaboration with other hospital departments. Organizes the follow-up appeals documentation post-audit and coordinates the submission of the Physician ... from a variety of sources (eg Auditors, CMS, BCBS, Permedion, DPH, Nurse Audit, HCHP, DPH, Disability, Workman's Comp, EHR, attorneys, patients, insurance… more
- Fallon Health (Worcester, MA)
- …we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for ... and notifications for FCHP members, screens for member eligibility, additional active insurance coverage and authorization history from the core system. + Initiates… more