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OPLA's responsibilities include representing the Department of Homeland Security (DHS) in proceedings before the Immigration Courts, representing DHS in appellate proceedings before the Board of Immigration Appeals, and providing support and direction to the Department of Justice, Office of Immigration Litigation as well as to the U.S. Attorney's Offices nationwide.
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Knowledge of reimbursement principles including pharmacy and medical benefit/buy & bill benefit design, coding, billing, prior authorization, and appeals processes. All responsibilities of the Associate Director will be carried out with strict adherence to the JJIM Credo and HCC Guidelines, in line with the FRM Rules of Engagement.
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The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life.
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Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies.
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This position is responsible for implementing and monitoring productivity standards, resolving issues, managing denials and appeals, reporting on payer performance, and ensuring adherence to policies and procedures.
$86,444 - $127,504 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Research and analyze law sources such as statutes, recorded judicial decisions, legal articles, treaties, constitutions and legal codes to prepare legal documents such as briefs, pleadings, or appeals, etc.
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Under the direction of the Sr. Director of Human Resources assists with the management of the progressive discipline and employee grievance process in a timely manner. Assists with the management of the Human Capital Management System (iSolved.
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The Onsite Support Representative (Medical Collections) will receive between 700 – 800 requests from collectors and billers, to mail appeals, medical records, and patient letters to payers and patients.
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Back End (insurance): Billing, collections to include denials and appeals and payment posting (manual and auto) We provide sober living for those in need of a structured, program-oriented, sober living environment while in the early stages of recovery from alcohol and/or drug addiction.
$20 - $30 an hourExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Communicates to Utilization Management Nurse data supporting denial appeals, or notification of potential denials. Reviews and analyzes third-party payer denials for in house patients, and communicates to attending physician , Case Management, Manager, Utilization Management Medical Director, and Utilization Management Nurse as per department protocols.
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The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies.
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Collaborates and coordinates with other experts, revenue agents, counsel attorneys, appeals officers, and/or specialists throughout IRS to leverage and expand expertise and ensure consistent application and interpretation of tax laws within those areas.
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Execute large-scale individual giving appeals/campaigns with a focus on developing comprehensive strategies to successfully hit appeal goal. Focused on acquisition, cultivation, stewardship, and long-term retention of donors, they will help grow and nurture the organizations philanthropic revenue stream with the support of the Fund Development team.
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Additionally, you will play a key role in resolving claim denials, supporting the appeals team when needed. We are currently looking for an Independent Contractor to join us as a Prior Authorization Specialist.
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Patient Admission and Continuity of CareReviews Patient Rights and Responsibilities, Grievance Procedure & Important Numbers Handout, FKC Non-discrimination policy, DNR Statement (if applicable) and address any immediate needs/concerns.
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grievance appeals jobs in Phoenix, AZ
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