- Houston Methodist (Houston, TX)
- …required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This ... other team members as advised by the Manager and/or Supervisor . + Identifies denial trends and notifies Supervisor...complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when… more
- WMCHealth (Valhalla, NY)
- …of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor . + Provides continuous education to physicians as needed ... within the regulatory timeframe of the request. + Provides clinical rational for standard and expedited appeals ....Provides clinical rational for standard and expedited appeals . + Participate in peer-to-peer review with payors and/or… more
- MTA (Brooklyn, NY)
- …SALARY : $ 190,000 - $ 195,000 DEPT/DIV: HQ/ Occupational Health Services (OHS) SUPERVISOR : Assistant Medical Director HOURS OF WORK: 7.5 hours per day LOCATION: 300 ... 3 days per week serving on the Paratransit Eligibility Appeals Board. The physician will provide medical expertise and...cases. + Work with Assistant Medical Director and other clinical staff members as needed on for medical policy… more
- Guthrie (Sayre, PA)
- …well as identifies, analyzes and takes the necessary action to submit complex appeals to insurance payers. Reviews all medical chart and account documentation in ... to determine appropriate coding and initiate corrected claims and appeals . Interprets payer guidelines, regulatory guidelines, contractual obligations and works… more
- City and County of San Francisco (San Francisco, CA)
- …validity of audited findings and conclusions and discuss with staff or unit supervisor . 3. Compile and submit statistical and narrative reports and provide evidence ... order to fulfill requests for additional documentation 6. Utilizes clinical interview techniques that include the ability to establish...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- Corewell Health (Grand Rapids, MI)
- …State and Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- State of Colorado (Sterling, CO)
- …Substance Use Disorder assessment and treatment services, and provide clinical and administrative supervision of Substance Use Disorder counselors. Responsibilities ... and all other duties associated with administrative supervision). + Clinical supervision (treatment planning, case conceptualization, group and individual treatment… more
- State of Colorado (Pueblo, CO)
- …SCCF SWC II 10251 MH 08/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 07/24/2025 Closing Date 8/7/2025 4:00 PM ... include formal and informal mental health evaluations, diagnostic assessments, and clinical interventions; + Assures accurate Information System mental health needs… more
- State of Colorado (Denver, CO)
- …As a supervisor , the Social Worker IV is responsible for clinical and administrative supervision, as well as performance management and disciplinary processes. ... interventions and comprehensive aftercare plans with placement. Services include clinical assessment, treatment planning, individual therapy, group therapy, family… more
- Idaho Division of Human Resources (ID)
- …Welfare; Division of Medicaid is currently recruiting aProgram Managerto oversee the Medicaid Appeals and Operations and Provider support teams within the Bureau of ... Clinical and Quality Management. This position will report to...Quality Management and will have direct oversight of Medicaid appeals and provider support initiatives within the Bureau. This… more
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