Anticipated End Date: 2025-01-24 Position Title: SCA Appeals Rep I (US) Job Description: SCA Appeals... Appeals Representative I position is an entry-level position in the NGS Appeals Department that reviews analyzes and processes...
Overview: Represents PHC in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating... dissatisfaction. Responsibilities: Independently determines best resolution on assigned cases, incorporating clinical guidance...
, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances...Anticipated End Date: 2025-01-27 Position Title: Manager II Grievances and Appeals (RN) Job Description: Manager...
and regulations. The Appeals Specialist is also responsible for the preparation of case files for both clinical and/or administrative... Review Organization (IRO) portals for submission of clinical appeals requiring matched-specialty review. Coordinates...
and regulations. The Appeals Specialist is also responsible for the preparation of case files for both clinical and/or administrative...Summary: The Appeals Specialist investigates appeals and grievances in accordance with established policies...
Overview: Now hiring a full time Denial/Appeals Specialist! Responsible for tracking, appealing and resolving... with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact...
Overview Now hiring a full time Denial/Appeals Specialist! Responsible for tracking, appealing and resolving denied.... From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided...
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical... 9:30am-6pm PST; Holiday rotation. Position Purpose: The Grievance and Appeals Assistant is responsible for ensuring...
clinical information for appeals and grievances (pre- and post-service denials) utilizing evidence-based medical criteria... HYBRID POSITION The Appeals & Grievances (Medical Auditor) RN conducts reviews of medical records, and plan documentation...
option Summary Facilitates the denial and appeal process through exercising clinical expertise and clinical by reviewing... medical records for medical necessity and policy requirements. Responsible for leveraging clinical knowledge and standard...
on the appeals and de-certification process as needed. Works closely with the appeals-dedicated Clinical Reviewers... in clinical Appeals Review and is an LPN – Required and Preferred. Must maintain a courteous and respectful disposition...
identified during the billing of claims and the follow-up on the clinical appeals performed by the facilities. Key... Responsibilities include: Responsible for appeals relating to technical and clinical issues identified during the billing of claims...
identified during the billing of claims and the follow-up on the clinical appeals performed by the facilities. Key... Responsibilities include: Responsible for appeals relating to technical and clinical issues identified during the billing of claims...
history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Appeals... and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member...
and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according to industry accepted clinical criteria... from payors for additional clinical documentation. § Acts as liaison between the Utilization and Appeals Management Department...
Description As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health... Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider...
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...
, to patients throughout the region. Position Overview: Manages and reviews clinical denial appeals to payers. Coordinates... appeals for clinical denials to managed care/insurance companies and governmental agencies. Writes clinical appeals and audits...
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 of business...
together. Work at home! The Appeals and Grievances Medical Director is responsible for ongoing clinical review... and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. You’ll enjoy the flexibility to work...