- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with... and grievances to find the root cause of denials . Duties Continued Check, verifies and ensure that all… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... + Experience in healthcare or revenue cycle - specifically insurance claim denials . + Strong analytical and organizational skills. + Excellent communication and… more
- Humana (Madison, WI)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- TEKsystems (San Bernardino, CA)
- Clinical Appeals Nurse - Revenue Cycle Management We are looking for a Clinical Appeals Nurse to join our Revenue Cycle Management team. In this role, you will ... play a critical part in managing clinical denials related to medical necessity, level of care, DRG...+ Prepare comprehensive clinical documentation and narratives to support appeals . + Submit and track appeals through… more
- Healthfirst (FL)
- …development and resolution of non-clinical cases, such as: certain types of claim denials , member complaints, and member and provider appeals . The end-to-end ... the Job Aid and//or regulatory timeframes.** + **Prepare and submit well documented appeals in accordance with payer guidelines and within timely filing limits** +… more
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal requests ... entities. This individual acts as a primary liaison for clinical denials , navigating appeal processes through all delegated levels. Key responsibilities include… more
- System One (Las Vegas, NV)
- …approvals and denials , notify care management team of LTSS approvals and denials , and support the appeals process as needed + Collaborate with Care ... Managers and/or providers to collect clinical documentation required for LTSS reviews of personal care/self-directed services. + Within the electronic health record and verification visit systems: verify eligibility, review existing documents to include, but… more
- Mount Sinai Health System (New York, NY)
- …providers/practices to ensure timely charge entry. 6. May run and work missing charges, edits, denials list and process appeals . Posts denials in EPIC/IDX on ... a timely basis. 7. Posts all payments in IDX using approved methodologies. 8. May perform specialty coding for services and medical office visits and review physician coding and provide updated to physicians and staff. 9. Works TES, BAR and eCommerce edits for… more
- New York State Civil Service (Queens Village, NY)
- …and assist in contacting insurance company for preauthorization payments, and/or file appeals on denials of preauthorization. * Participating in the formulation, ... management, development, and oversight of services.* Providing full range of clinical and administrative supervision to subordinate staff; may act as shift supervisor.* Participating in clinical leadership and in committees or work groups as assigned.*… more
- Guthrie (Binghamton, NY)
- …for review and determination of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review REMS clearance for ... monthly refills of high-risk medications ordered for patients Monitor and Manage Department in Basket + E-Guthrie Medical Advice Requests + Medication Cancellation notifications + Electronic Refill Requests + System generated Medication Authorization Request +… more