- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE:… more
- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- Healthfirst (NY)
- …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
- Healthfirst (NY)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + ... Work within a framework that measures productivity and quality for each Specialist against expectations + Additional duties as assigned **Minimum Qualifications** +… more
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop internal… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- Genesis Healthcare (Seven Fields, PA)
- …with our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up of denied ... Part-Time team members. + **Support for New Grads & Clinical Fellows:** Our Powerback Clinical Mentorship Program...response from the payer and takes appropriate action, including appeals , based on the type of denial. Documents all… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... benefits and commitment to diversity and inclusion. **Overview** The Clinical & Coding Specialist -Senior will be responsible...They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise… more