Manager, Behavioral Health Appeals - Florida

We are seeking a Clinical Claim & Appeal Specialist to review insurance denials and write strong, clinically-supported appeals to ensure accurate claim payment. · ResponsibilitiesReview denial letters and identify denial codes, reasons, and appeal deadlines · Write persuasive, ev ...

Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. · Gather, analyze and report verbal and written member and provider complaints, grievances and appeals, · ...

The Appeal Specialist is responsible for handling bill review appeals nationally from health care providers · and works as a liaison between IMS and claims adjusters to facilitate bill processing.High School Diploma or GED required. · Excellent written and verbal communication s ...

Come lead with us at Corporate At Houston Methodist this position combines clinical business regulatory knowledge skill to reduce significant financial risk exposure caused by concurrent retrospective denial payments services provided reviewing denials level care medical necessit ...

We are seeking a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding appropriately to appeals from providers; reviewing documentation to ensure all aspects of the appeal have been ...

Summary: The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and quality standards. The incumbent will investigate, audi ...

The Insurance Follow Up/Verifier is responsible for all inpatient/outpatient areas, including but not limited to: scheduled surgeries, the inpatient census reports, on-line systems provided by multiple payers to verify insurance eligibility, obtain benefits, obtain required autho ...

We are seeking a highly skilled Medical Biller with specialized experience in cardiology to join our team. · Accurately process and submit claims for electrophysiology procedures and related services to insurance companies. · Review and verify coding accuracy... · ...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...

· Position Purpose: With the (PHCO) Population Health and Clinical Operations PMO team, you will be part of Population Health project management initiatives and demonstrate a proven track record of successfully leading business (non-IT) clinical systems migrations. Business area ...

Quest Corporation of America seeks a Senior Graphic Designer with experience in graphic design and leadership roles. · ...

Job Summary · We are seeking a dedicated and detail-oriented Medical Biller/Collector to join our healthcare administrative team. The ideal candidate will possess a comprehensive understanding of medical billing processes, coding systems, and collections procedures. In this role, ...

· Requisition No: · Agency: State Courts System · Working Title: Staff Attorney/Senior Staff Attorney/Career Staff Attorney- Central Staff · Pay Plan: State Courts System · Position Number: · Salary:  $5,769.90-$7,360.34/month  · Posting Closing Date: 04/30/2026  · Total Comp ...

The Appeals Referral Specialist is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.The role requires associates to be in-office 3 days per week and provides flexibility to support productivity and wor ...

We are seeking an experienced Revenue Cycle Specialist to manage end-to-end billing operations for multiple physician and mental health clients. · ...

Baptist Health is seeking a Charge Integrity Associate 2 to coordinate billing services in their Miami-Dade region. · ...

Baptist Health is a not-for-profit healthcare organization with 12 hospitals and over 28,000 employees. We are seeking a Charge Integrity Associate to coordinate billing services. The successful candidate will have experience in charge entry or claims management and possess stron ...

Baptist Health is the region's largest not-for-profit healthcare organization with 12 hospitals and over 28,000 employees. We create personal connections with our colleagues and form meaningful relationships with patients. · ...

Clinical Operations Medical Director responsible for supporting medical management staff ensuring timely and consistent medical decisions to members and providers. · ...

Our employees are at the heart of what we do: helping people, businesses and society prosper in good times and be resilient in bad times. When you join our team, you are bringing this purpose to life alongside a passionate community. · Feel empowered to learn and grow while being ...