- 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
- CVS Health (Columbus, OH)
- …health care more personal, convenient and affordable. Position SummaryCreated grievance and appeals cases in the G&A system and sends acknowledgement letters to ... members and providersRequired QualificationsData Entry SkillsPreferred QualificationsOrganized, ability to multi-task, Detail orientedEducationHigh Scholl Diploma or GED Pay Range The typical pay range for this role is: $17.00 - $28.45 This pay range… more
- CVS Health (Harrisburg, PA)
- …unit. Work in a face paced environment to oversee the resolution of appeals , meeting the internal and external regulatory guidance. Required Qualifications We will ... be looking for candidates with strong communication and organization skills. Preferred Qualifications Experience with Medicare. Education High School Diploma Pay Range The typical pay range for this role is: $17.00 - $28.45 This pay range represents the base… more
- Glens Falls Hospital (Glens Falls, NY)
- …**Allied Health - Health Information Management* **Title:** *Coding Reimbursement Appeals Supervisor - Health Information Management (HIM) * **Location:** *NY-Glens ... Position ensures Glens Falls Hospital submits codes that reflect the acuity of our patient and DRG's that include all MCC's and CC's for reimbursement. In collaboration with Hospital External Review Team (HERT) members, coordinates reviews and responds to… more
- Penske (Reading, PA)
- …This position will support the audit team in the management of the retrieval and analysis of data supporting Penske and affiliates operating tax audits. **Major ... Responsibilities:** + Manage multiple projects simultaneously involving multiple cross-functional teams. + Analyze and prioritize project activities to establish realistic deadlines. + Oversight of the collection, analysis, and the review of data and… more
- CVS Health (Harrisburg, PA)
- …The Medicare Grievance Sr. Coordinator will fully research and resolve beneficiary complaints. Candidates can live anywhere US These complaints can include various ... issues and may require coordination with various departments to fully reach resolution. Responses must be timely and include member focused solutions in both written and oral format. Ideal candidates will have Medicare knowledge, customer service experience,… more
- University of Virginia (Charlottesville, VA)
- …+ Works complex denials with a high degree of accuracy and timeliness. Responds to inquiries from patients, clinical departments, and third parties by way of ... telephone, written correspondence and personal contacts. + Adds/corrects registration, insurance, and demographic data in the EPIC billing system to ensure accurate records. + Analyzes and prepares applicable adjustments to physicians' fees in compliance with… more
- CVS Health (Harrisburg, PA)
- …The Associate Manager will assist in the hiring and managing of the Medicare Complaints Team staff. The Associate Manager must possess outstanding people skills, ... exercise good judgement, and contribute to a team environment. Ability to build positive relationships. + Responsible for supervision and evaluation of daily activities for all staff. + Accountable for meeting the financial, operational, and quality objectives… more
- CVS Health (New York, NY)
- …Designs and develops decision models that analyze and evaluate actual and/or potential scenarios and simulate outcomes to facilitate informed decision-making. ... Leverages advanced analytical tools, decision modeling techniques, and data-driven insights to support strategic decision-making, optimize healthcare processes, and improve patient outcomes. Major Responsibilities + Designs and implements decision models that… more