Medicare Appeal Reviewer jobs

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REHAB QUALITY REVIEWER
Must maintain knowledge of current and changing Medicare regulations. The Rehab Quality Reviewer (RQR) serves as a support resource to the facilities’ needs in...
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Care Manager
Successfully appeals denials, when indicated. Prevents denials through pro-active intervention with managed care reviewers, physicians and hospital staff....
Sponsored by Eastern Connecticut Health Network
Utilization Review Nurse
Washington Hospital Center - 172 reviews - Washington, DC 20022
Knowledge of reimbursement models (commercial, managed care, Medicare) is preferred. Serves as communication liaison between registered nurse case managers,...
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REHAB QUALITY REVIEWER

Life Care Centers of America - 1,071 reviews - Cleveland, TN
Must maintain knowledge of current and changing Medicare regulations. The Rehab Quality Reviewer (RQR) serves as a support resource to the facilities’ needs in...

Review Coordinator (Maryland)

Livanta - 9 reviews - Annapolis Junction, MD 20701  +1 location
Staffs the Medicare Beneficiary Helpline during work hours. Minimum of 2-4 years of experience in clinical decision making, relative to Medicare patients....

Appeals & Grievances QA Auditing Specialist

L.A. Care Health Plan - 28 reviews - Los Angeles, CA 90017
Previous experience with Medi-Cal and Medicare in a managed care environment. Care Health Plan is seeking an Appeals & Grievances QA Auditing Specialist....

Case Manager

Centegra Health System - 47 reviews - Woodstock, IL 60098  +1 location
Oversees the Medicare Important Message process and coordinates appeals as needed with the Professional Review Organization....

Information System Support Coordinator

Noland Home Office - Birmingham, AL 35242
Obtaining required Medicaid and Medicare documentation as appropriately assigned. Assist in monitoring and communication of timelines associated with Recover...
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Clinical Appeals & Grievance Specialist I

Care1st Health Plan - 21 reviews - Monterey Park, CA
Interact with external appeal agencies as necessary to support second level appeal cases, e.g Independent Medical Reviewer (IMR), CMS QIO, State Fair Hearings,...

Behavioral Health Case Manager I - III

Anthem, Inc. - 1,780 reviews - Kansas
May also manage appeals for services denied. Family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination....

Grievance Coordinator-Redding

Partnership HealthPlan of CA - Redding, CA
External third-party reviewers, physician reviewers, and independent review entities (e.g. Level and above appeals....

Grievance & Appeals Quality Reviewer

Visiting Nurse Service of New York - 169 reviews - Manhattan, NY
Identifies and resolves operational quality problems and inefficiencies within the Grievance & Appeals (G&A) department....

Benefits Determination Coordinator

New Directions Behavioral Health - 11 reviews - Kansas City, MO
Monitor time standards and assist retrospective reviewers with adherence to time-frames. Coordinate with the appeals team on the retrospective review process....
Registered Nurse - Appeals Reviewer
Edge Recruitment Solutions - Tampa, FL
We’re working on behalf of a NYSE-listed company in Tampa that focuses exclusively on providing government-sponsored managed care services, primarily through...
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Grievance Coordinator-Redding
Partnership HealthPlan of CA - Redding, CA
External third-party reviewers, physician reviewers, and independent review entities (e.g. Level and above appeals....
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