- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the full life ... cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this...Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director** is responsible for the appeal reviews for physical health… more
- Avera (Sioux Falls, SD)
- …Communicate coding updates and changes to appropriate individuals. + Coordinate and/or complete insurance appeals on denied claims due to coding issues. + Assist ... functions when unable to resolve them and their remittances. + Review all insurance bulletins and refers information to other personnel as appropriate. + Provide… more
- Conduent (Baton Rouge, LA)
- …you eager to learn new skills and help adults in need?** As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH) Office ... **In this remote role, you will:** + Review decision/denial letters on new appeals requests received, research data and materials to accumulate evidence, draft and… more
- Centene Corporation (Jefferson City, MO)
- …utilization and health care quality + Oversee and actively participate in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in ... and other ad hoc committees + Collaborate closely with clinical teams, appeals team, and network providers to ensure understanding and adherence to utilization… more
- Robert Half Office Team (Minneapolis, MN)
- …looking for a rewarding remote role in healthcare administration? This Clinical Appeals Representative position offers the opportunity to make a meaningful impact ... while working from the comfort of your home. As a Clinical Appeals Representative, you will play a key role in managing the intake and processing of grievances and… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- University of Washington (Seattle, WA)
- …patients, their families, and their caregivers + Manage prescriptions and assist with insurance appeals for specialty medications + Handle the care coordination ... and continuity of care process + Administer specialty medications, including intramuscular injections + Support providers during minimally invasive procedures **REQUIREMENTS** + 2 years of recent ambulatory clinic or medical-surgical nursing experience +… more
- Humana (Lincoln, NE)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
- Providence (Torrance, CA)
- …responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside ... + Case management certification upon hire. + Experience working with denials and appeals in/for an acute care setting. + Experience in a multi-hospital and/or… more
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