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Written formal appeals using appropriate medical management tools for medical necessity determination ( MCG/Interqual/ CMS guidelines). Serves as liaison between hospital and eQ health, CMS and when appropriate their Contractors such as the MAC, QIO, ALJ, Medicare Council, and the RAC and prepares appeals for all of the above.
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The Patient Advocate meets with the patient or representative who registers a complaint or grievance in a timely manner to review the complaint or grievance and obtain needed information.
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Support the local HRBP in the employee appeals and grievance process. Support the local HRBP in the employee appeals and grievance process. Facilitates initiatives to foster a positive employee relations environment that aligns with the mission and values of Adventist Health System.
$31.83 - $47.74Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications. The Patient Access Specialist will support the healthcare providers in addressing questions regarding coding and billing and navigating complex reimbursement issues.
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Supports Lead Analysts and management in the maintenance of software databases, filing and tracking assessments, appeals, and tax bills. Prepares tax savings and refund calculations for client invoicing, working closely with consultants to track properties throughout the appeal and tax bill process, and manages deadlines accordingly.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and/or Manager. Location: Advent Health Trickle Building.
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Address claim denials and rejections through coding or medical necessity appeals, implementing corrective actions to prevent recurrence. Evaluate and report on the accuracy of various coding elements, preparing audit findings reports and providing education and training to ensure compliance and revenue integrity.
$24 - $30ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Requires a H.S. diploma and a minimum of 2 years of experience in billing and appeals process in Medicare/MediCal, including medical office experience; or any combination of education and experience, which would provide an equivalent background.
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Utilization Management Coordinator - RN Denials & Appeals (Experience a must) UM Coordinator - RN. Utilization Management Coordinator - RN Denials & Appeals (Experience a must) We offer a continuum of mental health and addiction services in a confidential, caring environment that promote crisis resolution, positive self- awareness, personal growth and problem-solving capabilities.
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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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Process SAP appeals in conjunction with a student advisor; responsible for making recommendation to the University's SAP appeal committee. In addition, the Dean of Nursing - Associate Nurse Administrator assists the nurse administrator in the fulfillment of the goals of the nursing program(s) and achieving the nursing program's end-of-program student learning outcomes and program outcomes.
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Resolve student appeals pertaining to their financial aid eligibility/awards. Meet with students to analyze student eligibility for financial aid; review and approve student loans. The Associate Director of Financial Aid conducts overviews for student financial aid, entrance and exit interviews, and packages financial aid for all new student enrollments, as well as, continuing students.
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A written response or resolution letter is provided to or sent to the patient or representative and includes the name(s) of the hospital contact person, the steps taken on behalf of the patient to investigate the complaint or grievance, the results of the grievance process and the date on completion.
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What We're Seeking : Hands-on expertise across all facets of litigation, from law and motion to depositions, trials, and appeals, with strong oral and written advocacy skills. Civil Litigation Associate Attorney - Orlando, FL Premier law firm is seeking solid civil litigation attorneys to join their expanding team.
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Position SummaryAs a Coordinator, Revenue Cycle, you will work in a pharmacy operation setting at our Patient Financial Service Centers, supporting the claims follow up, denial and appeals processes.
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grievance appeals jobs in Maitland, FL
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