- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor ** , you will help support clinicians who ... this remote position. **Here's what you will experience working as a Clinical Appeals Supervisor :** + Track and monitor the workflow of the clinical team daily… more
- Point32Health (Watertown, MA)
- …colleagues and communities. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Centene Corporation (Austin, TX)
- …perspective on workplace flexibility. POSITION IS REMOTE THIS TEAM PROCESSES APPEALS ONLY Appeals Experience HIGHLY Preferred **Position Purpose:** Supervise ... and interpretation of state/federal regulations and NCQA standards impacting member appeals and grievances from a clinical perspective. Ensure that the clinical… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...Federal and State Regulations. Complete individual summary scorecards for Supervisor feedback. + Track monthly scores on spreadsheet and… more
- Conduent (East Hartford, CT)
- …be part of a culture where individuality is noticed and valued every day. ** Appeals Coordinator - Customer Experience Associate IV** **Summary:** As an ** Appeals ... Coordinator - Customer Experience** analyze and resolve verbal and written appeals from consumers. Respond to requests for information from Department Hearing… 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 ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- Penske (Reading, PA)
- …audits, including negotiating with auditors and interfacing with taxing jurisdictions. -Perfect appeals and refund claims. -The position will require the ability to ... vendors and related companies -Other projects and tasks as assigned by supervisor **Qualifications:** -2 years of tax experience preferred -A Bachelor's degree is… more
- Robert Half Finance & Accounting (Asheville, NC)
- Description We are looking for a skilled Billing Supervisor /Manager to oversee medical billing processes and ensure the accuracy and efficiency of claims management ... a dedicated and detail-oriented individual with expertise in medical billing, appeals handling, and insurance claims management. The ideal candidate will bring… more
- Kelly Services (Horsham, PA)
- …final reimbursement amounts against expense limits + Managing reimbursement escalations and appeals with PSRS Supervisor + Completing the Reimbursement Expense ... to patient or caregiver following approval of the PSRS Supervisor + Managing check requests process in partnership with...+ Follow up and advocate until approval from PSRS Supervisor is received to secure reimbursements for patients/caregivers +… more
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