- Humana (Honolulu, HI)
- …with review policies, procedures, and performance standards. Represents Humana at Administrative Law Judge hearings. Exercises independent judgment and decision ... making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. **Schedule is Monday-Friday with intermittent… more
- Humana (Topeka, KS)
- …coverage policies, procedures, and performance standards. CMD represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and ... decision making on complex issues regarding job duties and related tasks; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business needs. **After an initial training period, schedule… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …success rates and trends; including denials that have been escalated to the Medicare Administrative Law Judge (ALJ). + Represent DFCI at ALJ hearings for ... Medicare denials. + Serve as a resource to other departments both within and outside DFCI to prepare appeals, respond to audits and support DFCI initiatives. + Document key business process workflows, policies and procedures. + Adhere to HIPAA and… more
- State of Minnesota (St. Paul, MN)
- …experience, judicial clerking, and case adjudication as a criminal, civil, or administrative law judge . **Preferred Qualifications** + Knowledge of any of ... the Early Childhood administration's programs, including but not limited to ECFE, Child Care Assistance, Help Me Grow, and Parent Aware, or the underlying federal and state laws for the administration's programs. + Experience working in a… more
- TEKsystems (Annapolis, MD)
- …process (eg, mediators, arbitrators, legal counsel) * Helps present appeals arguments to Administrative Law Judge , if and when appropriate * Otherwise monitors ... and follows up on appeals throughout entire process, determining next steps to ensure appeals either result in an overturned denial or have proceeded as far as possible * Identifies gaps in clinical documentation and works with clinical staff to develop and… more
- WellSpan Health (York, PA)
- …institutes appropriate courses of action. + Prepares detailed appeals and attends Medicare Administrative Law Judge (ALJ) hearings as necessary for Medicare + ... Interacts with providers, managers, and staff in departments to ensure correct coding of claims. + Maintains current knowledge of payer/insurance policies, rules and regulations, including state and federal guidelines. + Demonstrates initiative and… more
- City of New York (New York, NY)
- …hearings, including giving testimony. - Provide technical assistance to the Administrative Law Judge of the Environmental Control Board. Physical/Environmental ... Factors: Climbing ladders, pits confined spaces, lift heavy items, standing for prolonged times, all weather conditions, kneeling, mandatory overtime, nights and weekends and may work Tuesday through Saturday schedules Note: Only those serving in the civil… more
- City of New York (New York, NY)
- …hearings, including giving testimony. - Provide technical assistance to the Administrative Law Judge of the Environmental Control Board. Physical/Environmental ... Factors: Climbing ladders, pits confined spaces, lift heavy items, standing for prolonged times, all weather conditions, kneeling, mandatory overtime, nights and weekends and may work Tuesday through Saturday schedules Note: Only those serving in the permanent… more
- Mohawk Valley Health System (Utica, NY)
- …the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as a liaison with payers to ... facilitate approvals and prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals. (Peer-to-peer, retrospective/closed record review, concurrent appeals). +… more
- St. Luke's University Health Network (Allentown, PA)
- …team and work independently to resolve such issues. + Participate as needed in Administrative Law Judge (ALJ) hearings. + Spends approximately 20% of their time ... weekly coding/abstracting patient medical records according to ICD-10-CM/PCS, UHDDS and CMS guidelines. Utilizes the 3M Encoder to verify and assign ICD-10-CM/PCS diagnosis and procedure codes, and MS-DRG assignment. + Performs data entry of coded patient… more