Clinical Appeals Reviewer - United States

This position reviews provider billing/claims appeals and reconsiderations, supports legal responses to medical billing disputes, and ensures compliance with Workers' Compensation regulations and best practices. · ...

Paradigm is seeking a full-time, remote Provider Appeals and Legal Liaison to lead the interface between the Medical Bill Review/Claims team and Paradigm's Legal department. · Workers' Compensation Medical Bill Review and Provider Appeals · ...

The Manager is responsible for the day-to-day Appeals and Denials process by providing general oversight including leadership for the inpatient DRG/Coding Denials and Appeals process which includes tracking prioritizing trending and writing appeal letters identifying training and ...

This customer service representative role involves providing expertise and general support to teams in reviewing appeals and grievances, communicating with internal parties regarding issues, implications, and decisions. · ...

The position provides support for claims activities including reviewing and resolving member and provider complaints in accordance with the standards established by the Centers for Medicare and Medicaid Services. · ...

The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. · ...

The Clinical Appeals Manager will work in conjunction with the Director of Clinical Appeals. The Manager will oversee the daily operations of a Clinical Appeals team and will assist in the planning, implementation, and execution of department and organizational goals. · Leads a t ...

The Appeals Support Representative role directly supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team.Essential Job Functions: · Complete outbound calls to payers for status updates on retro authorizat ...

Join our dynamic healthcare team as a Medical Claim Appeals Specialist. · Review and analyze denied or disputed insurance claims to identify reasons for denial and determine appropriate appeal strategies · Maintain organized records of all claim correspondence,Collaborate with he ...

The Board of Review hears appeals from ministers or credentialed religious educators who have had their final fellowship or credentialing status terminated by the Ministerial Fellowship Committee or the Religious Education Credentialing Committee. · ...

The Utilization Management Manager is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, · continued stays, utilization practices and discharge planning according to approved clinically valid criteria. · Assigns ...

Acentra Health exists to empower better health outcomes through technology services clinical expertise Our mission innovate health solutions deliver maximum value impact Lead Way open invitation embrace mission actively engage problem-solving take ownership work day Acentra Healt ...

+ Academic Appeals Specialist + · American Public University System +The Academic Appeals Specialist is responsible for responding to student appeal requests, investigating and delivering appropriate appeal outcomes,+Responsibilities:Serves as a point of contact for first-level e ...

The DRG Denials Auditor conducts hospital inpatient DRG denial audits. · Reviews patient records for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. · Evaluates present on admission (POA) indicators, discharge disposition, and any other r ...

The Clinical Review Nurse performs clinical pre-screening of claims to identify clinical errors. · Assist Negotiation team with provider communication, obtaining a corrected claim or letter of agreement, based on audit findings and financial benchmarks. · ...

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Orthopedic Surgeons with an active New York medical license and Workers Compensation Board Certification to conduct ...

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Psychiatrists with an active New York medical license and Workers Compensation Board Certification to conduct Utiliz ...

This position is responsible for managing the appeal of unpaid claims in the Central Business Office. · Review and appeal unpaid claims daily. · Completes follow-up work on appealed claims. · ...

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Orthopedic Surgeons with an active New York medical license and Workers Compensation Board Certification to conduct ...

Analyze, triage, investigate, research and process standard and escalated appeals , complaints or state complaints from members , providers , health plans and state agencies . · Able to work overtime as needed. · ...