- MaineGeneral Health (Augusta, ME)
- Job Summary: MaineGeneral Health is seeking a qualified RN Clinical Appeals Specialist to support our Revenue Cycle team by reviewing denied insurance claims ... mission of exceptional patient care Job Description: Position: RN Clinical Appeals Specialist Location: Alfond Center for Health, AugustaSchedule:… more
- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... Appeals process. + Respond to Prior Authorization denials and submit appeals , collecting appropriate clinical support to substantiate the formal response. +… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Molina Healthcare (Tacoma, WA)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- Dana-Farber Cancer Institute (Brookline, MA)
- The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities ... (CAR) T-cell therapy, and other immune effector cell treatments. The Specialist works autonomously to secure initial and ongoing authorizations, monitor… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a ... for licensure by examination or reciprocity is required. The Clinical Pharmacy Specialist provides clinical ...in managing member care through the prior authorization and appeals process for medications. These services will be provided… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4889241) Apply Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction… more
- State of Colorado (Pueblo, CO)
- Clinical Safety Specialist I - CMHHIP...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4957279) Apply Clinical Safety Specialist I - CMHHIP Salary $27.10 - $37.94 Hourly… more
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