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...
General Summary of Position Responsible for coordinating and monitoring the denial management and appeals process.... Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused...
is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies... together. In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant...
is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies... together. In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant...
is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies... together. In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant...
is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies... together. In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Assistant...
of clinical appeals requiring matched-specialty review. Coordinates with IROs on time-sensitive cases, and availability... improvements. In addition to processing Clinical cases, Senior Appeals Specialists may handle administrative Complaints...
use of medications, potential drug interactions, and clinical status for appeals requests Conduct Quality Assurance and verify the.... Primary Responsibilities: Evaluate prescriptions and patient histories Interpret physicians' prescriptions and clinical...
Summary of need: We are seeking a highly motivated and experienced Grievance & Appeals Nurse Specialist... to join our team. The Grievance and Appeals Nurse Specialist participates in managing medical appeals and state hearing reviews...
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...
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...
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...
. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis...-CM/PCS official code set, or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals...
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...
updated records in various systems Review claim denials for clinical issues, prepare appeals, and manage each case's resolution... audits and appeals. Leverage your expertise to support UCLA Health's commitment to accuracy and quality in claim processing...
will pay between $18.00 and $24.00/hr based on experience The Acute Coding Appeals Specialist integrates medical coding... principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG...
. Join us to start Caring. Connecting. Growing together. As a Pharmacist Intern with OptumRx's Prior Authorization & Appeals team..., you will get the opportunity to work with a team of clinical pharmacists to achieve overall performance objectives to the...
with Utilization Review is also key. The Appeals coordinator must be proficient in evidence based clinical screening criteria, MCG...Job Summary: The Appeals Coordinator is responsible for the review, response (including appeals), and trending...
clinical experience, 3 years UR/CM experience, written and verbal communication and interpersonal skills, knowledge...
by conducting a comprehensive review of clinical documentation to determine if an appeal is warranted. Where warranted, the Denials... Management RN will collect, organize and present pertinent clinical information to third party payers. The Denials Management RN...