- Dana-Farber Cancer Institute (Brookline, MA)
- …managing medical denials by conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling ... clinical prior authorization review and preparing and managing clinical appeals . **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:** + Knowledge of… more
- Robert Half Accountemps (Ontario, CA)
- Description We are looking for a detail-oriented Clinical Appeals Reviewer to join our team in Ontario, California. In this role, you will be responsible for ... coordinating and managing documentation related to clinical appeals , ensuring compliance with health plan timelines. This is a long-term contract position… more
- CommonSpirit Health (Englewood, CO)
- …We are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and ... regulations, including CMS rules and the Two-Midnight Rule, while leveraging clinical criteria and prioritizing medical necessity to defend inpatient status. This… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist...posted for a minimum of seven calendar days. The review and selection process may begin as early as ... **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. The Clinical... Appeals Specialist role is entirely remote. The Clinical Denials Prevention & Appeals Specialist plays… more
- Catholic Health (Buffalo, NY)
- …with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the ... people, carrying out and documenting the appeals process for denied claims denied due to reasons...and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health… more
- LA Care Health Plan (Los Angeles, CA)
- …(A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances ... for accuracy, clarity, and cultural appropriateness and sensitivity. + Review and monitor procedures for identifying quality of care...appeals & grievance process. Create a best in clinical appeals process that is efficient and… more
- Insight Global (Ontario, CA)
- …days, depending on type of request). This person will be handling grievances and appeals for the front line staff health plans (internal PQI - Potential Quality ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- HCA Healthcare (Nashville, TN)
- … Appeals Analyst researches and Resolves High Dollar Technical and Top Dollar Clinical Appeals through concise understanding of Payer Contract Language and ... an organization that invests in you as a Senior Appeals Analyst? At Parallon, you come first. HCA Healthcare...action. **What you will do in this role:** + Review technical and clinical denial arguments for… more
- McLaren Health Care (Grand Blanc, MI)
- …activities and commercial appeals beyond the first level, requiring complex clinical review and appeal letter writing. Responsible for collecting, analyzing, ... Medicaid, and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review , including role, responsibilities… more
- BJC HealthCare (St. Louis, MO)
- …About the Role** BJC HealthCare is seeking a Patient Accounts Analyst to join our clinical appeals team! In this role, you will be analyzing trends for insurance ... appeals and denials as well as participating in provider...is not limited to cash posting, billing, and the review & reconciliation of individual patient accounts. This position… more