- Evolent (Columbus, OH)
- …Stay for the culture. **What You'll Be Doing:** Job Description 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...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… more
- Elevance Health (Mason, OH)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in...approve or summarize and route to nursing and/or medical staff for review. + The grievance and appeal work… more
- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Elevance Health (Mason, OH)
- …medical care is received and for the day-to-day management of medical management staff . **How will you make an impact:** + Interpret existing policies and develop ... aspects of the program. + Support the medical management staff ensuring timely. + Consistent responses to members and...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- CommonSpirit Health at Home (Loveland, OH)
- …certifications. Proficiency in billing and collections processes, with a focus on insurance appeals and account resolution.. At CommonSpirit Health at Home, ... Level II is a mid-level role responsible for resolving insurance and self-pay accounts, including managing claim appeals...resource to team members and assists in training new staff . + Support the organization's mission by aligning with… more
- ProMedica Health System (Toledo, OH)
- …and staff . 4. Research and communicate government and private insurance carrier coding/billing policies and guidelines to appropriate providers and staff ... of coding denials or other payer requests; performs appropriate follow up including appeals and corrective actions with departments and staff . 8. Assist in… more
- Evolent (Columbus, OH)
- …outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a physician`s input ... expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls)...+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely… more
- Evolent (Columbus, OH)
- …outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a physician`s input ... of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- Evolent (Columbus, OH)
- …outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a physician`s input ... of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- Evolent (Columbus, OH)
- …outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a physician`s input ... of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency… more