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Oversees coding practices and clinical documentation, grievance, and appeals processes (including pharmacy), and conducts reviews for durable medical equipment (DME), genetic testing, etc. Oversees coding practices and clinical documentation, grievance, and appeals processes (including pharmacy), and conducts reviews for durable medical equipment (DME), genetic testing, etc.
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You can make a difference by volunteering in a position that appeals to you and allows you to use your unique skills and talents. From the Ability Network, our Asian American & Pacific Islander Resource Group, the Latino Resource Group, and Red Cross PRIDE, tothe Umoja African American Resource Group, our Veterans+ Resource Group, and the Women's Resource Group, these networks provide connections, mentoring and help give voice to important concerns and opinions.
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Manage assigned member appeals and grievance cases from documentation, to investigation, and through resolution, ensuring the final disposition of a member's appeal or grievance is compliant with the regulatory requirements set-forth by NCQA, DOI, CMS, DOL and any state or federal specific regulations that apply.
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This role supports our Appeals and Grievances team. SKILLS:Above average experience with Excel, Microsoft SQL Server query coding, and Azure Databricks query coding Experience with SSRS & PowerBI is a plus.
Starting at $44,936.59 - $97,362.61 a year depends on education, experienceFull-timeRemoteExpandUpdated 2 days ago - UpvoteDownvoteShare Job
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Partner with MT HR team members and act as liaison with benefit vendors for escalated employee issues, appeals. We are seeking a skilled Benefits Specialist who will focus on the facilitation of employee health, welfare, and retirement benefit plans to ensure compliance with applicable laws and recordkeeping requirements.
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Oversee management of all fundraising functions including planned giving, corporate partnerships, non-governmental grants, mail and on-line appeals and events. The Advancement Director is responsible for the cultivation and growth of all non-government revenue sources including corporate relations, grants, prospects, annual giving, third-party fundraisers, special campaigns, planned giving, events, communications, and strategic partnerships.
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
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Support field in education of office personnel on prior authorization and appeals processes, reimbursement support through Dupixent MyWay, free drug programs and financial assistance programs. Field Reimbursement Manager (FRM), Pulmonology and Gastroenterology - Kansas.
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Physician / Cardiology / Ohio / Permanent / Associate Medical Director - Cardiology - Remote Job Job
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Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is requiredNo nights, no weekends, not call.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Must have general payer policy knowledge including public & private payers, foundational knowledge of benefit verifications & prior authorization/pre-determination requirements (including appeals/exceptions), & knowledge of access & reimbursement processes within various sites of care.
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Graduates include justices of the Supreme Court of Ohio, federal appeals and district court judges, U.S. senators, U.S. representatives, governors, managing partners in law firms of all sizes, chief executive officers of Fortune 500 corporations, professors at law schools across the country, and prominent attorneys in private practice, government service, and public interest law firms.
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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.
$118,000 - $203,550 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Participate in the Appeals and Grievance process, as necessary, to assure timely, accurate responses to members. Participate in the Appeals and Grievance process, as necessary, to assure timely, accurate responses to members.
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Independent Office of Appeals: SPECIALIZED EXAM PRGRMS & REFERRALS (SEP&R) 1 position will be filled in the Independent Office of Appeals: SPECIALIZED EXAM PRGRMS & REFERRALS (SEP&R), Area 11, Team 2.
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Provides education and facilitates coordination on insurance appeals and funding for oncology treatments. Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery.
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appeals job in Columbus, OH
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