The Appeals Coordinator is responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsib

Assess the clinical indicators and suggestions of various query requests received from the MD Reviewer/ DRG Integrity Specialist Collaborate and communicate as necessary to clarify and avoid misinterpretation to ensure the query is optimally written and distributed to the correct client provider Creates queries in a compliant manner in accordance with AHIMA and ACDIS comp

Processes credentialing and re credentialing applications for the client. Reviews applications and prepares verification letters. Contacts various departments, licensing agencies, and insurance carriers to complete credentialing and re credentialing applications. Provides support to the client in the collection and query of credentials of members of the client. Conducts P

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Review and ensure all required documentation is present within the medical record. While also paying attention to all details and ensuring that that patient confidentiality guidelines are adhered to, to safeguard patient medical information. Required to work within many different computer environments. Qualifications HS High School Grad or Equivalent (Required) Medical Re

The Healthcare Data Analyst provides data analysis support to the customer by assisting with the development of reports and/or dashboards to monitor program and operational performance. Promotes self service analytics for customer adoption, understanding and use of data. Supports design of programmatic analyses and reporting capabilities in addition to business requiremen

Start the day excited to make a difference...end the day knowing you did. Come join our team. Job Summary The Medical Billing Specialist is responsible for processing all third party primary and secondary insurance claims for ancillary professional services. The incumbent in this position performs insurance billing, account follow up, and collections on all outstanding ba

In collaboration with the Registered Nurse, under the direction of the Attending Physician and Clinic Operations Manager, directs patient flow, assists staff members in carrying out patient treatments, assists in specimen collection, phlebotomy and laboratory testing, and maintains a safe, clean and stocked ambulatory setting. Preps patients for visits to ensure smooth cl

The Physician Advisor conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billi

Health Information Specialist II Job Locations US VA Alexandria Requisition ID 2024 36006 # of Openings 1 Category (Portal Searching) Operations Position Type (Portal Searching) Employee Full Time Overview Who we are... Datavant protects, connects, and delivers the world's health data to power better decisions and advance human health. We are a data logistics company for

Medical Records Manager Job Locations US Requisition ID 2024 146294 Position Category Administration Business Line Operations Clearance No Clearance Required Sector Defense Mission & Health Solutions Responsibilities We are looking to add a Medical Records Manager to our team of professionals. The Medical Records Manager will be primarily responsible for ensuring adherenc

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At The GIANT Company, we are passionate about building strong families and healthy communities, serving millions of neighbors across Pennsylvania, Maryland, Virginia, West Virginia, and New Jersey. We are committed to being an inclusive place to work and shop. Our shared values of care, courage, integrity, teamwork, and humor guide our work as we embrace the unique talent

Health Information Operations Supervisor Onsite Job Locations US VA Norfolk Requisition ID 2024 35520 # of Openings 1 Category (Portal Searching) Operations Position Type (Portal Searching) Employee Full Time Overview Who we are... Datavant protects, connects, and delivers the world's health data to power better decisions and advance human health. We are a data logistics