Utilization Management Appeals Coordinator

Job TitleAbout the RoleThe Utilization Management Appeals Coordinator will be responsible for overseeing all denial and appeal activities, ensuring compliance with nationally recognized criteria for medical necessity determinations.Duties and ResponsibilitiesReview clinical information for appeals, utilizing nationally recognized criteria to determine...

Job SummaryAbout This PositionThis Utilization Management Appeals Coordinator position requires a highly skilled individual to oversee denial and appeal activities, ensuring compliance with nationally recognized criteria.Main ResponsibilitiesManage the appeal process, reviewing clinical information and determining medical necessity of services...

Job OverviewResponsibilitiesThis role requires a skilled professional to manage denial and appeal activities, including Expedited Appeals, Standard Appeals, External Independent Reviews, Retrospective Reviews, and State Fair Hearings.Key AccountabilitiesOversee the appeal process, reviewing clinical information and determining medical necessity of services...

Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Patient Access-Pre-Visit Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page...

Job DescriptionLocation: Chicago, IllinoisBusiness Unit: Rush Medical CenterHospital: Rush University Medical CenterDepartment: Patient Access-Pre-VisitWork Type: Full Time (Total FTE between 0.9 and 1.0)Shift: Shift 1Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)Rush offers exceptional rewards and benefits learn more at our Rush benefits page

About the Role: The Clinical Appeals and Denials Support Specialist (CADSS) will report to the Manager of Appeals & Peer to Peer Operations. Primary responsibility but not limited to- follow up on outstanding appeals at 30, 45, 60, and 75 intervals. Proficient in navigating and documenting within internal document system. CADSS will access Insurance...

Responsibilities JOB SUMMARY: Performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party reviewers, effectively coordinating collection of all supporting...

Clinical Coding Appeal Specialist Job ResponsibilitiesThis is a specialist role that involves managing clinical coding appeals processes and developing effective strategies to overcome denied claims. You will be responsible for supervising clinical coders and coordinating their work to meet productivity and quality standards.Supervise clinical coders and...

The Director of Unemployment Insurance Appeals will play a key role in ensuring the fair and efficient administration of unemployment insurance appeals cases. As a member of the Illinois Department of Employment Security, this individual will be responsible for directing subordinate staff in conducting hearings and preparing decisions on appeals cases. This...

Clinical Coding Appeals Leader">As a Clinical Coding Appeals Leader, you will play a crucial role in ensuring the accuracy and quality of medical coding for inpatient and outpatient claims. You will oversee the day-to-day operations of the coding team, including tracking daily inventory of cases and coordinating assignments to ensure productivity and quality...