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58 fresh jobs found

Associate Director, Denials and Appeals
US Remote

Accounts receivable management PHI Privacy Billing Management HIPAA/PHI Privacy PHI Denials management Security Training ICD-10 Coding Policies and procedures +54

Senior Mid Full Time

USD 133K+

Program Relations Manager
CAN - ON - Remote, Canada

AmerisourceBergen

Reimbursement support Liaison Appeals CAD Patient Support Pharmaceutical sales Clinical support Pharmaceutical Industry Consultation +36

CAD 65K+

Medical Director--Claims Management
Remote US, United States

Inpatient care Clinical patient care Computer-Based Review Outpatient services Home health services Grievance and appeals processes Clinical reference materials CMS policies Post-acute care +87

Exec Senior Full Time

USD 223K+

Medical Director - Florida
Remote US, United States

Clinical patient care Health claims Managed Care Knowledge Post-acute services Home health services Family practice Inpatient rehabilitation Hospitalist National Guidelines +73

Exec Senior Full Time

USD 223K+

Clinical Legal Advisor - Administrative Appeals
Remote US, United States

Teaming Drafting legal documents Adobe Professional Functional strategies Appeals Consumer Experiences Legal research Adobe Clinical support +36

USD 104K+

Case Manager, Patient Services (West Coast Based Candidates)
Remote (United States), United States

PTC Therapeutics, Inc.

Pharmacy billing Peer-to-peer review Patient Engagement Appeals Prior authorization Patient services Active Listening Data Entry Case Management +10

USD 81K+

Field Reimbursement Specialist - Birmingham, AL
US - Alabama - Montgomery - Field/Remote, United States

Patient health information Benefits investigation Payer prior authorization Reimbursement Process Budgets Claims resolution Denials Payer Reimbursement Issues +48

USD 155K+

Field Reimbursement Manager, Respiratory and Dermatology - Pensacola, FL/ Mobile, AL
Remote, US, United States

Access Issue Resolution Reimbursement support Respiratory Financial assistance Patient Support Services Patient Support Programs Dermatology Appeals Prior authorization +29

Senior Mid Full Time

USD 122K+

RN Clinical Review Clinician_Appeals
Remote-CA, United States

Centene Corporation

Appeals processes Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations Researching NCQA Clinical Review Guidelines +27

USD 95K+

Field Reimbursement Specialist - Detroit, MI
US - Michigan - Detroit-Field/Remote, United States

Benefits investigation Payer prior authorization Patient health information Reimbursement Process Budgets Claims resolution Denials Payer Access and Reimbursement +48

USD 155K+

Administrative Appeals Chief Hearing Officer
REMOTE OPTIONS, PHOENIX

State of Arizona

Statutory Interpretation Legal principles Administrative Law Rules of Evidence Case management systems Federal and state laws State laws Research methods Arizona Administrative Code +37

Exec Senior Full Time

USD 90K+

Administrative Counsel
REMOTE OPTIONS, PHOENIX

State of Arizona

Administrative Law Rules of Evidence Vocational rehabilitation Federal and state laws State laws Arizona Administrative Code Policies and procedures Regulatory Guidance Performance measures +38

Senior Mid Full Time

USD 110K+

Supervisor, Clinical Grievance and Appeals
Remote-MO, United States

Centene Corporation

Appeals management Grievance Grievances Ncqa standards Quality Metrics NCQA Regulatory reporting Medical necessity Appeals +31

USD 68K+

Field Reimbursement Specialist
USA - WA - Remote, United States

AmerisourceBergen

Formulary Buy and bill Coverage management Specialty distribution Benefit investigations Patient assistance Educational presentations Pharmacy benefits Practice Management +29

USD 86K+

Senior Field Reimbursement Specialist
USA - DC - Remote, United States

AmerisourceBergen

Specialty distribution Formulary Coverage management Buy and bill Benefit investigations Educational presentations Patient assistance Pharmacy benefits Reimbursement support +58

Senior Full Time

USD 98K+

Public Programs Specialist
Remote-CA, United States

Centene Corporation

Member access Provider network management Clinical Management Grievances Healthcare Collaboration Health care services Service coordination Pharmacy Technician Medical Review +25

Entry Mid Full Time

USD 77K+

Supervisor, Appeals Grievance
Remote-MO, United States

Centene Corporation

Appeals management Grievance Grievance resolution Grievances Performance Evaluation Appeals Health Plan Counseling Trend Analysis +26

USD 55K+

MSP Services Administrator
Dallas-Fort Worth Metropolitan Area, TX, USA

Ethos Risk Services

MSP Services Medicare Compliance Submissions Appeals Medical terminology Investigation Time Management Microsoft Office Analytical +1

USD 55K+

Remote Medical Director - Texas
Remote-TX, United States

Centene Corporation

Culturally diverse care Medical management programs Health care quality Health financing Provider network development Government programs Clinical quality improvement Health administration Accreditation Standards +41

Exec Senior Full Time

USD 231K+

Medical Director - Medicare Grievances and Appeals Corporate
Remote US, United States

General surgery Preservice appeals Health claims Grievances Medical interpretation Hospitalist Family practice Medical background Geriatrics +41

Exec Senior Full Time

USD 246K+

Grievance & Appeals Coordinator I
Remote-NY, United States

Centene Corporation

Grievance Claims research Grievance resolution Grievances Managed care experience Researching HEDIS Organizing Appeals +17

Entry Mid Full Time

USD 64K+

Patient Access Specialist
USA - SC - Remote, United States

AmerisourceBergen

Benefits verification Patient assistance Billing and Coding Appeals Medical Billing Prior authorization Patient services Patient Access Healthcare industry +31

USD 42K+

Benefits Verification Specialist
USA - FL - Remote, United States

AmerisourceBergen

Benefits verification Insurance benefits Strong interpersonal Billing and Coding Appeals Medical Billing Prior authorization Patient services Patient Access +30

USD 32K+

Manager, Quality Improvement
Remote-FL, United States

Centene Corporation

Appeals Accreditation Clinical Experience Quality improvement Procedures Supervisory Quality Management Managed Care Nursing +15

USD 86K+

PASRR Coordinator
REMOTE OPTIONS, PHOENIX

State of Arizona

Arizona Administrative Code Program Coordination Medicaid programs Program Planning Federal and state laws Data Tracking Report development Policies and procedures State laws +41

USD 52K+

Case Manager - Rare Disease - US Remote
US - Oregon - Portland - Field/Remote, United States

Denials Patient Support Programs Reimbursement Issues Marketing Operations Pharmacovigilance Appeals Medical Information Medical Science Liaison FDA +26

USD 86K+

Grievance & Appeals Coordinator I
Remote-AZ, United States

Centene Corporation

Grievance Claims research Grievances Managed care experience Researching Claims resolution Organizing Appeals Tracking +16

USD 38K+

Medical Director - Medicaid N. Central
Remote US, United States

Health claims review Computer-Based Review Post-acute services Grievance and appeals processes Post-acute care Humana policies Family practice Clinical group practice management Medical interpretation +92

Exec Senior Full Time

USD 223K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Claims review Health financing Medical management programs Provider network development Health care quality Government programs Clinical quality improvement Health administration Personnel management +40

Exec Mid Full Time

USD 231K+

Behavioral Health Prior Authorization Manager
REMOTE OPTIONS, PHOENIX

State of Arizona

Medicaid programs Program Planning Health care services Report development Policies and procedures Review Equal Opportunity Provider Relations Eligibility verification +51

USD 83K+

Independent Dispute Resolution Analyst
US Remote

Trend Identification PHI Policy compliance Submissions Denial Management Policies and procedures Dispute resolution Insurance Verification Cell-free DNA +22

Entry Mid Full Time

USD 77K+

Medical Director - Care Plus
Remote US, United States

Grievance processes Health claims review Outpatient services Grievance and appeals processes Post-acute care Clinical group practice management Commercial health insurance Hospitalist Inpatient rehabilitation +90

Exec Senior Full Time

USD 223K+

Remote Marketplace Medical Director
Remote-MO, United States

Centene Corporation

Claims review Medical management programs Provider network development Government programs Health care quality Health financing Clinical quality improvement Personnel management Health administration +39

Exec Mid Full Time

USD 231K+

R-205825 Case Manager - Rare Disease- KRYSTEXXA- Central-Remote
US - Texas - Houston - Field/Remote, United States

Insurance authorization Patient Support Programs Denials Reimbursement Issues Pharmacovigilance Medical Information Appeals Specialty Pharmacy Medical Science Liaison +24

USD 86K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Outpatient services Grievance and appeals processes Post-acute care Humana policies Hospitalist Medical interpretation National Guidelines Family practice +83

Exec Mid Full Time

USD 223K+

Remote Medical Director (PRN) - Missouri
Remote-MO, United States

Centene Corporation

Education Development Claims review Medical management programs Provider network development Government programs Health care quality Clinical quality improvement Health financing Personnel management +41

Exec Mid Part Time

USD 212K+

Field Reimbursement Specialist
USA - CA - Remote, United States

AmerisourceBergen

Formulary Benefit investigations Specialty distribution Buy and bill Coverage management Educational presentations Pharmacy benefits Patient assistance Reimbursement support +29

USD 86K+

Corporate Income Tax Auditor 3
REMOTE OPTIONS, PHOENIX

State of Arizona

Mathematical computation Tax Law GAAS Auditing standards AMS System Maintenance Windows Environment Policies and procedures Reviewing +46

Senior Mid Full Time

USD 58K+

Transaction Privilege Tax Auditor 3, Marijuana Tax
REMOTE OPTIONS, PHOENIX

State of Arizona

Mathematical computation Transaction privilege tax Use tax Tax Law Field audits GAAS Tax laws AMS Windows Environment +44

USD 48K+

Medical Director - Southeast Region
Remote US, United States

Computer-Based Review Health claims review Post-acute services Grievance and appeals processes Outpatient services Inpatient rehabilitation Post-acute care Clinical group practice management Commercial health insurance +87

Exec Senior Full Time

USD 223K+

Supervisor, Grievance & Appeals
Remote-FL, United States

Centene Corporation

Provider post service appeals Hospital claims Grievance Healthcare law Grievances Appeals Quality Metrics Medical management Health Services +18

USD 55K+

Medical Director
Remote-OH, United States

Centene Corporation

Substance Use Disorders Medical management programs Clinical quality improvement Health care quality Utilization Provider network development Government programs Health financing Accreditation Standards +45

Exec Senior Full Time

USD 221K+

Director, Grievances & Appeals
Remote US, United States

CMS guidelines Audit Preparation STARS Grievance and appeals Grievances Healthcare Regulations Control Appeals Analytic +59

Exec Senior Full Time

USD 126K+

Remote Medical Director - South Carolina
Remote-SC, United States

Centene Corporation

Utilization Medical management programs Clinical quality improvement Health care quality Government programs Provider network development Health financing Personnel management Accreditation Standards +39

Exec Mid Full Time

USD 221K+

Field Reimbursement Specialist
USA - NV - Remote, United States

AmerisourceBergen

Formulary Benefit investigations Buy and bill Coverage management Specialty distribution Medical Benefits Educational presentations Pharmacy benefits Patient assistance +30

USD 86K+

Remote Child / Adolescent Medical Director - Florida
Remote-FL, United States

Centene Corporation

Utilization Claims review Clinical quality improvement Medical management programs Health care quality Provider network development Health financing Personnel management Accreditation Standards +39

Exec Senior Full Time

USD 231K+

Medical Director - Gulf South
Remote US, United States

Post-acute services Grievance and appeals processes Community Groups Outpatient services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +88

Exec Senior Full Time

USD 223K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Community Groups Outpatient services Grievance and appeals processes Inpatient rehabilitation Commercial health insurance Clinical group practice management Post-acute care Humana policies +83

Exec Senior Full Time

USD 223K+

Medical Director - Pacific SW
Remote US, United States

Health claims review Community Groups Outpatient services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +84

Exec Senior Full Time

USD 223K+

Remote Beahvioral Medical Director - Kentucky
Remote-KY, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Health care quality Medical management programs Health financing Provider network development Government programs Clinical Quality Medical Review +39

Exec Mid Full Time

USD 231K+

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