- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on … more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely ... remote. The Clinical Denials Prevention & Appeals Specialist plays a critical role in optimizing the revenue cycle and supporting accurate reimbursement for… more
- Cognizant (Phoenix, AZ)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... help you stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is a plus. We're excited to meet people… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity… more
- Nuvance Health (Danbury, CT)
- …critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- Stanford Health Care (Palo Alto, CA)
- …analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist ...Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and ... and in administrative hearing proceedings. Duties Include: + The Appeals and Grievance Specialist is responsible for...clinical setting, including 1-2 years Medicaid managed care appeals process & Health/Human Services. + Proven ability to… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... projects. + Independently partners with Medical Directors and other clinical support staff on appeals requiring ...Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...manner. This position will focus on quality review of non- clinical grievance and appeals cases for all… more
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