Job Description: Reporting to the MHN CDI Manager, the MHN CDI Clinical Coordinator is responsible for training... treatment modalities. Maintains and applies up-to-date knowledge of current clinical documentation practices to ensure the...
that have a strong clinical utilization management background. Medicare experience is a plus. Founded in 1934, Medical Mutual is the oldest... under limited supervision, evaluates clinical information using evidence-based guidelines, company policies and individual patient...
Anticipated End Date: 2025-02-14 Position Title: Grievance/Appeals Analyst I Job Description: Title: Grievance.../Appeals Analyst I Location: This position will work a remote model. Ideal candidates will live within 50 miles...
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical... perspective on workplace flexibility. Position Purpose: Analyze and resolve verbal and written claims and authorization appeals...
Job Description: Your Role The Medicare and Medical Appeals and Grievances team is responsible for clinically... reviewing member appeals and grievances that are the result of either a preservice, post service or claim denial. The Medicare...
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical... perspective on workplace flexibility. Position Purpose: Analyze and resolve verbal and written claims and authorization appeals...
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical... appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the...
ASP and claims adjudication processes. Work closely with clinical staff to ensure accurate appeals documentation... leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs...
and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested... and in accordance with applicable regulations or standards. •30% Performs thorough research of the substance of service appeals...
research of the substance of service appeals by both member and provider based on clinical documentation, contractual...Summary We are currently hiring for an RN Appeals Analyst to join BlueCross BlueShield of South Carolina. In this role...
Operation is seeking an experienced and highly motivated individual to join our team as a Senior Appeals Analyst. This position... is a dynamic role requiring the evaluation of disability claim appeals. In addition to managing a caseload of complex appeals...
seeks additional clinical documentation from the physician to optimize hospital reimbursement when appropriate. 3. Works... processes and participates in the resolution of retrospective reimbursement issues, including appeals, third-party payer...
Anticipated End Date: 2025-02-14 Position Title: Grievance/Appeals Analyst I Job Description: Title: Grievance.../Appeals Analyst I Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50...
for coordinating and appealing technical denials and working closely with the HIM Appeals Specialist responsible for clinical appeals... work on appealed claims. Works with insurance carriers on appeal issues. Ensure clinical appeals are submitted to the HIM...
Anticipated End Date: 2025-02-14 Position Title: Grievance/Appeals Analyst I (California... Only) Job Description: Title: Grievance/Appeals Analyst I Location: This position will work a remote model. Ideal candidates will live within 50...
for coordinating and appealing technical denials and working closely with the HIM Appeals Specialist responsible for clinical appeals... work on appealed claims. Works with insurance carriers on appeal issues. Ensure clinical appeals are submitted to the HIM...
. Primary Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical review... and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include...
. Primary Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical review... and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include...
case creation appeals workflow management, and interaction with the clinical appeals team. · Determines which issues... the people and communities we serve. Supervises the administrative staff in the Appeals department to include finalizing...
to create written and/or verbal clinical appeals with payers. The Analyst works closely with third party payors, Managed Care...Denials and Appeals Analyst Singing River Health System Administrative Building - Gautier | Full-Time | Monday-Friday...