- Evolent (Columbus, OH)
- …care aligned with clinical guidelines. + Collaborate with leadership, management, and clinical staff to address complex cases and support decision-making. + Act as a ... practices. + 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
- OhioHealth (Columbus, OH)
- …and Medical Assistants. This position works heavily in administrative tasks for insurance authorizations and denials/ appeals . Orientation is typically 12 weeks ... and we have a great learning culture with tenured staff of 20+ years to support onboarding needs. If you are looking for a role that allows you to work in a… more
- Highmark Health (Columbus, OH)
- …could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals , and system changes, etc.; provides ... ensuring timeliness and accuracy of all work given by support staff /management. Maintains accurate records, including timekeeping records and attends all required… more
- ProMedica Health System (Toledo, OH)
- …Nursing and Therapy Leadership to coordinate the timely management of insurance precertification, recertification, authorizations and appeals , length of stay, ... duties listed below are essential unless noted otherwise* 1. Conducts insurance verifications, precertification, and recertification as indicated. 2. Monitors and… more
- Adecco US, Inc. (Columbus, OH)
- …on-site or virtual training and education to healthcare providers and staff on reimbursement processes, including lunch-and-learns and scheduled presentations. Log ... Support (20%)** - Assist offices with claims, billing and coding, appeals , medical benefit interpretation, and co-pay or patient assistance programs. Coordinate… more
- Elevance Health (Dayton, OH)
- …+ May also serve as mentor, subject matter expert or preceptor for new staff , assisting in the formal training of associates, and may be involved in process ... + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a… more
- Elevance Health (Cincinnati, OH)
- …Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… more