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Clinical Appeals Coordinator Jobs

Authorization Appeals Coordinator Jobs
By Fred Hutch At Seattle, WA, United States
Present denial information to Revenue Cycle Management.
Working knowledge of ICD-10, CPT and HCPS coding
Ability to apply knowledge of commercial payor and regulatory guidelines
Ability to organize and prioritize concurrent responsibilities.
Ability to troubleshoot and offer solutions for process improvement.
Initiates appeals for denied authorization requests.
Appeals And Grievances Coordinator
By Clear Spring Health At Miramar, FL, United States

Candidates should have working knowledge of Medicare and member services or work in a health plan or health plan supprting vendor.

Appeals Coordinator Jobs
By W3R Consulting At Detroit, MI, United States
Preferred Skills/Experience Previous health care or health insurance industry experience
Education/Certifications Bachelor’s Degree in English, Communication, Health Care Administration, or related field
Job Title: Appeals Coordinator- 100% remote
•Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math
•Previous customer service or concierge experience
•Strong PC application and system skills- having the ability to navigate multiple computer systems and databases
Clinical Coordinator Jobs
By Gift of Hope Organ & Tissue Donor Network At Illinois, United States
Other candidates may be considered on an individual basis at the discretion of management, dependent on aligned job experience
Coordinate medical management of donation after circulatory death (DCD) donors with the hospital team to ensure appropriate hemodynamic status
Support staff through the referral process and provide additional education and information surrounding the donation process as needed
Participate in departmental quality assurance initiatives, meetings, educational activities and required training as assigned
Responsible for triage of organ referrals, obtaining clinical information to determine medical suitability, providing clinical assessment to determine organ viability
Create case plan for organ referrals including further needs once onsite staff involved.
Clinical Coordinator Jobs
By Arizona College of Nursing At Phoenix, AZ, United States
Manages relationships with hospitals, skilled nursing facilities, and other clinical agency sites for nursing students to complete clinical rotations.
Bachelor’s degree required or an equivalent combination of education and experience.
Requirements include problem-solving and critical thinking skills.
Develops innovative relationships with hospital educators and leadership to provide educational services.
Maintains knowledge and understanding of the College’s curriculum and programs and can clearly explain to clinical partners.
Facilitates recruitment of appropriate clinical preceptors utilized in assigned student clinical experiences.
Healthcare Appeals/Denials Coordinator - Remote | Wfh
By Get It Recruit - Healthcare At Los Angeles, CA, United States

Are you passionate about making a difference in the healthcare industry? Do you thrive in a dynamic environment where your skills are valued? We are currently seeking a dedicated Healthcare ...

Clinical Coordinator Jobs
By Wellness Together At , Remote $50 - $55 an hour
Excellent interpersonal and team management skills required.
2+ years of experience in practice management and/or clinical supervision preferred.
Knowledge of school-based therapy, public education policy, and FERPA desired.
Hosting the annual Student Mental Wellness Conference which partners with the CA Department of Education
Collaborates with the Clinical Director, Clinical Manager and Clinical Supervision team as needed.
Experience with chart review and utilization review.
100% Remote - Appeals & Grievances Non-Clinical Specialist - Medicare And Medicaid Knowledge Highly Preferred
By Healthfirst At Utah, United States
Experience working in care management systems, such as CCMS, TruCare or Hyland
Prior experience in a Managed Care or Healthcare environment
Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes and exceptional organizational skills.
Manage all duties within regulatory timeframes
Bachelor’s degree from an accredited institution or relevant work experience
Prior knowledge of Medicare and Medicaid health plans
Coordinator Complaint Appeals Jobs
By CVS Health At , , Ca $17.00 - $27.90 an hour
Research Standard Plan Design or Certification of Coverage (Evidence of Coverage) relevant to the member to determine accuracy/appropriateness of benefit/administrative denial.
Research Standard Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial.
Experience in reading or researching benefit language
Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation requirements.
Excellent verbal and written communication skills
Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics
Appeals Coordinator Level I
By MedReview Inc. At New York, NY, United States
Manage large volume of documents including faxing, downloading, and uploading from different databases or SFTP
Knowledge of organization of medical records and medical claims terminology preferred
Strong analytical skills with the ability to make timely and sound decisions to meet department standards
Good interpersonal and written/oral communications skills
Performs accurate categorization and appropriate triage upon receipt of each appeal or inquiry
Assures timelines and appropriateness of appeals
Clinical Appeals Pharmacist - Remote In Us
By UnitedHealthcare At , Minnetonka, 55345, Mn
Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid, and Commercial
Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills
2+ years of working experience as a licensed Pharmacist
Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
Experience working with onscreen document images
Proven excellent written and verbal communication skills
Appeals Coordinator - Remote (Ak, Az, Fl, Id, Or, & Wa)
By Moda Health At United States
6 months to 2 years of experience of medical/dental claims processor or customer service preferred.
Demonstrated knowledge of CMS rules for Medicare and Medicaid grievance, complaint and appeal processes preferred.
Knowledge and understanding of complaint and appeal procedures preferred.
Ability to interpret benefit contracts and/or Moda Health administrative policies, products, and business lines.
Demonstrated strong reading, verbal, written and interpersonal communication skills.
Demonstrated initiative, analytical, problem solving, and organizational skills.
Clinical Appeals Nurse Jobs
By Netsmart At United States
At least 3 years of case management, concurrent review or utilization management experience
Prepare professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients.
At least 5 years of clinical experience in acute care setting
Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials.
Bachelor of Science degree in Nursing
Proficiency in medical record review
Appeals Coordinator Jobs
By Anthem Blue Cross and Blue Shield At Norfolk, VA, United States

Experience in a behavioral health setting, managed care experience preferred, UM experience also preferred.

Appeals Coordinator Jobs
By Brighton Health Plan Solutions At United States
• Maintain broad knowledge of client products and services
• Strong knowledge of contracts, medical terminology, and claims processing and procedures
• 1+ year computer medical billing or claims adjudication systems experience
• Previous experience handling appeals and grievances
• High School Diploma or GED diploma; some college or business school education is a plus
Company: Brighton Health Plan Solutions
Appeals Coordinator Jobs
By Select Source International At Durham, NC, United States
Demonstrates high degree of appropriate knowledge of all areas of the plan.
Identify and create action plans to educate internal departments on benefit misinterpretation and/or claim payment system errors.
Audit and oversight of entities where delegation of member and provider appeals exists.
Answer member/provider questions via incoming telephone calls in a professional quality driven manner.
May handle complaints/grievances as defined by the federal government.
Appeals And Grievance Coordinator
By BroadPath At United States
2+ years of Medicare Appeals/Grievance experience required
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Excellent verbal and written communication skills
However, based on performance BroadPath can offer other opportunities based on availability once the contract ends.
Processing Medicare Appeals/Grievance with Medicare Part C or D experience
Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
Appeals Coordinator - Need Icd-10 Certification
By TalentBridge At Pittsford, NY, United States
Performing other duties as assigned by management
Associate's Degree from an accredited college or university or equivalent experience
At least two (2) years of experience in a medical billing, claims processing, or related position required
Job Duties Include, But Are Not Limited To
Minimum Qualifications for the position:
Review and analyze case file materials that involve claims payment disputes
Clinical Appeals Nurse Rn Wfh
By HCA Healthcare At Nashville, TN, United States
At least 1 year of case management experience required
Relevant education may substitute experience requirement
Education assistance (tuition, student loan, certification support, dependent scholarships)
Family support through fertility and family building benefits with Progyny and adoption assistance.
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Demonstrate the ability to interpret medical payer policy requirements.
Clinical Appeals - Rn
By Confluence Health At Wenatchee, WA, United States
Ability to write articulate and concise appeals by applying clinical knowledge, coding expertise and medical necessity.
Manages assigned workload of accounts so that appeals are submitted timely in accordance with payer timeframes.
Three (3) years of acute care experience or equivalent expertise.
Two (2) years’ experience in utilization review.
Strong attention to detail with excellent communication skills in both written and verbal forms.
2+ years experience working in the Epic system.