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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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In addition to the duties outlined above, the CRC-B will be responsible for start-up activities such as assisting with budget development, establishing workflows/pathways/operationalizing protocols, and creating/leading SIVs. The CRC-B will also be expected to regularly prepare, draft, and submit regulatory correspondence (e.g., ACC, IRB, and FDA) as appropriate.
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The Appeals Coordinator also acts as a patient advocate for members, when accessing the member's appeal rights. The Appeals Coordinator will use clinical support criteria and/or established department or medical policy and plan benefits to evaluate proposed delivery plans of treatment.
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Review audit requests from external regulatory and accrediting bodies; provide guidance to Compliance Office team members regarding responses and appeals; negotiate with payors and government entities as needed in collaboration with the Chief Compliance Officer, Division Director, Compliance, and the Legal Services Office as needed.
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The Litigation Group includes the Affirmative & General Litigations Unit, Civil Rights Unit, Tort Litigation Unit, Code Enforcement Unit, Labor & Employment Unit and Appeals Unit. The Code Enforcement Unit brings cases on behalf of the City of Philadelphia in a broad spectrum of enforcement matters against property owners and food handlers whose actions jeopardize the health, safety, and welfare of the public.
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Manager Precert & Clinical Appeals - (230016) Under the supervision of the Director of Clinical Appeals and Precertification, the Manager is responsible for daily operations of the Clinical Analysis and Appeal and Precertification activities for both the Temple Main campus, the inpatient Temple Bone Marrow Transplant Unit and targeted high dollar outpatient drug costs.
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This includes overseeing UMR reviews and any appeals processes. The Registered Nurse Assessment Coordinator (RNAC) provides for the initial assessment and periodic re-evaluation of all residents admitted to Skilled Nursing.
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Reviewing denials for exhausted MVA's and any other pertinent correspondence to be brought to collectors' attention for review/follow-up. Downloading WCAIS correspondence (WC) Assistance with prepping Physician, Medications, and DME Billing to include.
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The bartender will utilize their knowledge and expertise in the areas of beverage to prepare and serve a selection of wine, spirits, and cocktails that appeals directly to the guests' taste. Savour unparalleled fine-dining by Michelin-starred Chef Jean-Georges Vongerichten and inventive flavours by local James Beard Award-winner Chef Greg Vernick.
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Work on a team to produce correspondence/reports/biddable documents for water distribution systems; wastewater conveyance system; treatment plants; potable wells; water storage tanks; and water & sanitary pumping stations.
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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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Per the guidance of DOS Passport Specialists, generate correspondence to resolve application discrepancies, including: Return to Sender (RTS), Rewrites and Re-issues, and re-batch into the system.
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The successful candidate will be required to evaluate coverage, draft coverage correspondence, undertake claims investigations, manage defense counsel and legal spend, assess liability and financial exposure, and effectively negotiate cost effective, good faith claims resolutions.
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Primary responsibilities include assisting the Donor Relations Directors with moves management through database maintenance, recordkeeping, prospect research, event coordination and correspondence development and donor communication.
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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. Education: Associates degree in science required, MLT (ASCP) or MT(ASCP) certification preferred.
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appeals correspondence jobs in Philadelphia, PA
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