Appeals jobs in Newark, New Jersey (NJ) State

Appeal Analyst RN who will train new hire in the clinical role to complete Utilization Management Appeals and act as an RN I on the team. US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solu...

The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines. ...

Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Yes-as determined by the agency policy.Occasional travel - You may be expected to travel for this...

Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Yes-as determined by the agency policy.Occasional travel - You may be expected to travel for this...

This experience may have been gained through work experience as a project/program manager, team lead or project/program lead, technical advisor, or senior specialist/analyst that included managing resources, providing support to managers, mentoring team members, providing day to day guidance trai...

Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Yes-as determined by the agency policy.Occasional travel - You may be expected to travel for this...

Reviews and analyzes Revenue Agent (Examiner), Appeals Officer, and Counsel Attorney instructions, reports, case files, and support statements and interprets tax law court decisions and legal ...

Relying on clinical background, reviews health claims providing medical interpretation and ... reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post ...

Description & Requirements Maximus is seeking a 100% remote Collections Admin to join the Federal Fin/Acct team to assist with the State Appeals, NJ Appeals and State Arbitration projects. The Admin's primary focus will be with collections by running reports, conducting outreach in large vol...

Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part D appeals. Responsibilities of this Medical Director role are related to Medicare Appeals. Provide after hours and weekend coverage on a rotational basis to support 24/7 appeals work. Provide ongoin...

As a DRG Downgrade Appeals Clinician, you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on estab...

Soliant is hiring a Pharmacist t for a health system in Jersey City, NJ. In this role, the Pharmacistwill work in a Clinic setting. The pharmacist will work closely with physicians to ensure effective medication therapy for patients. ...

VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Fairview, New Jersey. Coordinates external case reviews requested by enrollees, including preparing and submitting documentation according to regulatory requirements and tracking external reviews througho...

VNS Health is seeking a Registered Nurse (RN) Utilization Review for a nursing job in Secaucus, New Jersey. Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient care review, including the design, testing and evaluation of the review met...

A paid Product Tester position is perfect for those looking for an entry-level opportunity, flexible or seasonal work, temporary work or part-time work. ...

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Data entry clerks come from all different backgrounds including, data entry, telemarketing, customer service, sales, clerical, secretary, administrative assistant, warehouse, inventory, receptionist, call center, part-time, retail fields & more. ...

Good Experience in SDLC & Requirement Authoring along with Veeva (Regulatory) skills.Proficiency in Jira story and agile is mandatory.Resource is expected to play a role of BA with following duties :.Create Quality Assurance Plan & Requirement Specs.Create Epic, Stories and Qualification Criteria...

Competitive pay / Health, vision, & dental / 401k matching / PTO / Equipment provided - As a Claims Customer Experience Specialist you'll: Serve as the primary point of contact for customers, providing professional and compassionate assistance throughout the claims process via phone, email, and o...

Medix is currently hiring for a Utilization Review Nurse/Care Manager within a Healthcare system in NJ. The Registered Nurse will provide case management/utilization review as well as routine discharge planning services to patients and their families, to facilitate safe and timely discharges, to ...

Pride Health is hiring an RN Case Manager for a client in NJ! (contract). Schedule and participate in family conferences, team meetings, and team case presentations. May write verbal orders from Provider in the chart in compliance with the state RN practice laws, and in compliance with individual...

We are seeking an RN Case Manager to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients. ...

Analyze and document transformation logic of data fields in data process, create data lineage diagrams for upstream and downstream data processes using data lineage tool including continuous improvements and controls. Liaise with Data Concierge function to support data requests and issues thru cl...

The BA is meant to work with business stakeholders and liaison between business and tech teams. Working with the business to get full business definitions. Ture business analyst background (Requirement gathering, Stakeholder communication , etc). This role will bridge the gap between the vendor a...