• Stanford Health Care (Palo Alto, CA)
    …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required ... **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in...Health Care's organization competencies and Code of Conduct. + Denial Analysis: Conduct thorough analyses of denials, evaluating the… more
    DirectEmployers Association (10/10/25)
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  • Appeals Specialist II - RN…

    Community Health Systems (Franklin, TN)
    **Job Summary** The Appeals Specialist II - RN , under the direction of the Director of Denial Support Services, logs and reviews per documentation ... denials that are resulting in retractions. As an Appeals Specialist II at Community Health Systems (CHS)...correlating with the follow-up teams. + Works closely with Denial Coordinator, Facility Denial Liaison, and Managed… more
    Community Health Systems (10/29/25)
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  • MassHealth & Medicare Regulatory Compliance…

    Commonwealth Care Alliance (Boston, MA)
    …Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational compliance with ... to compliance inquiries from internal teams regarding benefit design, denial logic, or claims workflows. * Assist in the...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
    Commonwealth Care Alliance (09/01/25)
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