- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... Must retain active and unrestricted licensure throughout employment. + Understanding of Appeals guidelines as applicable with URAC, NCQA, and ERISA. + Proficient in… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Appeals Coordinator is responsible for the timely and accurate triaging all appeals , ... information to process their requests within regulatory guidelines. The Appeals Coordinator is also responsible for daily/weekly/monthly department reporting, and… more
- Board of Veterans Appeals (Washington, DC)
- Summary The Chief Counsel of the Board of Veterans' Appeals (the Board) provides advice and recommendations to the Chairman and Vice Chairman on all issues impacting ... This position is located in the Board of Veterans' Appeals , Office of the Chief Counsel and reports to...of the day-to-day operations of the Board of Veterans' Appeals . Ensures Board decisions comply with statutory requirements, including… more
- Highmark Health (Harrisburg, PA)
- …of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... all involved parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers. in addition to promoting departmental awareness of coding best practices. This position reports directly to the Supervisor… more
- Adecco US, Inc. (Ontario, CA)
- …currently assisting a local client in their search to fill a **Clinical Appeals Reviewer** job opportunity located in **Ontario, CA** 91764 zip code. **Shift:** Mon ... Healthcare industry experience **Apply Today** to be considered for this **Clinical Appeals Reviewer** job and any other positions with Adecco **.** **Pay Details:**… more
- Robert Half Accountemps (Ontario, CA)
- …needed * Exhibit professional phone presence during all interactions * Engage in the appeals process when necessary * Understand and adhere to the timeline for each ... and entity formation * Skill in interviewing for data collection and handling appeals * Knowledge of offshore operations and health plans, specifically TRICARE and… more
- Kansas Judicial Branch (Topeka, KS)
- Position Number: K0073940 Location of Employment: Kansas Court of Appeals , Kansas Judicial Center 301 SW 10th Ave, Topeka, Kansas 66612 The selected candidate may ... work for the Hon. Judge Amy Fellows Cline of the Kansas Court of Appeals . A research attorney reviews the briefs and underlying case record, research questions of… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
- CVS Health (Tallahassee, FL)
- …from multiple business units. Ensure timely, customer focused response to complaints/ appeals . Identify trends and emerging issues and report and recommend ... Able to interpret benefits. - Healthcare experience. - 1 plus years working with appeals , claims, or compliance. (and/ or) - 1 plus years experience working with… more