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Kosher Food Option Available | Medical Insurance | Paid Holidays | Paid Vacation | Parental Leave | Sick Days. Serve as production manager for mail and electronic appeals, social media fundraising, newsletters, and donor correspondence.
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Reports directly to the JHH VP of Care Coordination/Utilization Management and indirectly to the JHBMC Senior Director of Care Management and is responsible for the coordination, management and success of The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center Utilization Management programs.
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Support multiple program areas across TennCare, including the Office of Program Integrity, the Chief Medical Office, Managed Care Ops, and TennCare appeals units. TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities.
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Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities.
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Your benefits for this role will include paid time off; dental, medical, and vision coverage; profit sharing; disability and life insurance; a cafeteria plan; a 401(k) plus match; and paid jury duty leave.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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For insurance specific clients: 1+ year medical provider experience working with UB04, appeals & denials. + Medical, Rx, Dental & Vision Insurance. Appeals & Denials.
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Utilizes clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.
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Two to three years of experience working in health insurance industry with focus on medical provider contracting, relations, and/or medical provider billing and coding. Wages are one component of Wellfleet’s total compensation and benefits package, which includes medical, vision and dental insurance options, life and accident insurance, 401(k), and short-term and long-term disability insurance.
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The area is home to two medical schools, one veterinary school, two nursing schools, two law schools—including Western Michigan University and Michigan State University—a Big Ten Conference university (Michigan State), the Michigan State Capitol, the state Supreme Court, the Court of Appeals, a federal court, the Library of Michigan and Historical Center, and headquarters of four national insurance companies.
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Competitive Compensation and Benefits : Enjoy an attractive benefits package, firm-sponsored professional development for associates, regular firm-wide Attorney-Retreat, CLE allowances, licensing expense reimbursement, competitive annual bonus opportunities, medical/vision/dental/disability/life insurance, 401(k) and profit sharing, parental leave, and firm provided devices including a cell phone, and more.
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1+ year’s medical provider experience working with UB04, appeals & denials. Insurance Patient Account Representative - Hospital A/R Emphasis. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
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Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants Performs case reviews and appeals for all health plans.
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The Medical Billing / Collection Specialist is responsible for assisting patients by communicating with insurance payors via various methods (i.e. telephone, fax, internet) to determine eligible benefits and acquiring Pre-Certification(s) when deemed necessary by the insurance payor.
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0-2 years medical provider experience working with UB04, appeals & denials. Making outbound calls to Insurance Companies to resolve claim denials and account balances. Performing Non-Clinical Appeals.
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medical insurance appeals jobs
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