- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health ... pre-certification required. Licensure Requirements: None. Apply/Share Job Title INSURANCE APPEALS SENIOR ID 4357425 Facility Covenant Health Corporate… more
- CenterWell (Nashville, TN)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a Quality Control Senior Manager you want with your current employer? We have an exciting ... plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving… more
- Akumin (TN)
- We are seeking an experienced, strategic, and results-driven Senior Director of Billing and Collections to lead our end-to-end billing operations. This senior ... **Collections & Accounts Receivable** + Direct the collections strategy for both insurance and patient receivables, focusing on reducing aging AR and improving DSO.… more
- Cardinal Health (Nashville, TN)
- …relationships of trust with customers and internal business partners. The Insurance Follow-up Collector generates revenue by monitoring and pursuing payment on ... goals to maximize cash flow. Responsibilities + Reverification of insurance benefits if missed by front office + Able...importance and relationship to patient care + Consults with appeals department for disputed / denied claims. + Works… more
- BrightSpring Health Services (Chattanooga, TN)
- …Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners within plan ... for our Signature Advantage Plan who will work with senior care partners to assist in enrolling new residents...Insurance License required. + Experience working with the senior population preferred. + Ability to organize and manage… more
- Evolent (Nashville, TN)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Nashville, TN)
- …(NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals . + Ensures documentation of all communications with medical office staff ... overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in… more
- Evolent (Nashville, TN)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Nashville, TN)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more