- 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
- Healthfirst (MA)
- …OR Dental Hygienist Preferred Qualifications: + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, ... and Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… 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
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... Reporting to the Prior Authorization Superv isor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Beth Israel Lahey Health (Cambridge, MA)
- …skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review. ... & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality...knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of… more
- Dana-Farber Cancer Institute (Brookline, MA)
- The Drug Authorization Specialist , with direct supervision of the Prior Authorization Supervisor, is responsible for managing all work related to drug authorizations ... to all aspects of drug prior authorization work. The Drug Authorization Specialist creates accurate, thorough, and concise prior authorization requests to all payers… more
- Intermountain Health (Boston, MA)
- …provides advanced training to hospital coding staff, compliance, CDI, physicians, and clinical staff. This Coordinator serves as a subject matter expert for all ... of hospital coding. The coordinator works with providers and clinical staff to make critical coding decisions based on...compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades… more
- Evolent (Boston, MA)
- …guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations ... Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular… more
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