Clinical Appeals Coordinator Job at Robert Half (Eden Prairie)

Patient Financial Services Coordinator

We are seeking a Patient Financial Services Coordinator to join a world-renowned...

Location

United States , Boston

Salary:

20.00 - 21.00 USD / Hour

Daley and Associates

Expiration Date

Until further notice

Requirements

Bachelor's degree in Health Science, Business, Healthcare Administration, or a related field preferred
1+ years of relevant experience in a healthcare setting (hospital, clinic, physician's office), including registration, billing, insurance verification, or financial counseling (internships included)
Proficiency in Microsoft Office
experience with Epic or other electronic medical record (EMR) systems is a plus
Experience with insurance verification, benefits analysis, prior authorizations, or financial clearance strongly preferred
Familiarity with ICD-10, CPT codes, medical terminology, and healthcare insurance regulations preferred
Understanding of managed care, prior authorization processes, and radiology billing and reimbursement practices preferred
Experience supporting diagnostic imaging, radiology, or procedural services is a plus
Excellent communication and customer service skills, with the ability to collaborate effectively across clinical and administrative teams
Strong analytical, organizational, and problem-solving skills, with keen attention to detail

Job Responsibility

Accept and process radiology referrals and service requests, initiating a comprehensive benefits review and completing all necessary registration and financial clearance steps
Verify insurance eligibility and coverage for radiology services and imaging procedures, including diagnostic, interventional, and follow-up care
Obtain and secure prior authorizations and pre-certifications by submitting required clinical documentation to insurance carriers
Prepare and maintain accurate patient financial records, ensuring all demographic, insurance, and authorization information is current
Serve as a liaison between patients, radiology providers, scheduling teams, and insurance payers to facilitate timely access to services
Communicate patients' financial clearance status to clinical and scheduling teams to support efficient care delivery
Assist patients and providers in navigating insurance denials and appeals, including coordinating peer-to-peer reviews when necessary
Educate patients and families regarding insurance coverage, out-of-pocket expenses, financial policies, and available financial assistance programs
Prepare and present Financial Waivers and Advanced Beneficiary Notices (ABNs) for services with limited or no insurance coverage
Ensure compliance with radiology billing and reimbursement guidelines, including accurate documentation and billing plan updates

Fulltime

New

Rn Coordinator

Location

United States , New York

Salary:

110000.00 - 120000.00 USD / Year

MJHS

Expiration Date

Until further notice

Requirements

Graduate of accredited nursing program
BSN preferred
2 years managed care or hospital based utilization/case management experience
2 years minimum clinical experience
Licensed nurse in New York State
Proficiency with Microsoft Word, Excel, Power Point and Outlook is required
Must have excellent written and verbal communication skills
Must be comfortable researching current evidence based practice guidelines and protocols
Must be able to multi-task and managed multiple projects efficiently, meet deadlines, demonstrate analytical/critical thinking skills, and provide excellent customer services that leads to positive problem resolution

Job Responsibility

The RN Coordinator will investigate and respond to written and/or verbal clinical appeals, expedited clinical grievances and potential quality of care grievances submitted by members and providers in accordance with Elderplan Contract Benefits, CMS (Centers for Medicare & Medicaid Services), and DOH (Department of Health) regulations.

What we offer

Sign-on Bonuses OR Student Loan Assistance for clinical staff
MSN in Education offered
Tuition Reimbursement for all full and part-time staff
Dependent Tuition Reimbursement for clinical staff
Generous paid time off, including your birthday
Affordable and comprehensive medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Flexible spending
Paid Student Loan Forgiveness Program (PSLF)

Fulltime

Clinical Accreditation Program Consultant

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

5 years of above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management, Medical Appeals and Grievance (MAG), Quality Management and/or Accreditation and Medicare requirements.
3 years of experience in clinical and health insurance or other healthcare related field
2 years of Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management, Medical Appeals and Grievance (MAG), Quality Management and/or Accreditation and Medicare requirements.
Associate degree in Nursing or Post High School Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse

Job Responsibility

Develop and document health improvement/management programs for members in compliance with applicable state, federal, accreditation and Medicare regulations.
Support business processes and data flows and how they affect health management/BCBS processes, systems and other operational areas
Participate in and/or lead process improvement, quality for accreditation or Medicare improvement projects
Analyze and/or oversight of program data collection and reports to evaluate current programs.
Research and analyze procedural problems and provide recommendations for improvements and changes
Consult and coordinate with various internal departments, external plans, providers, vendors, businesses and government agencies to obtain information to meet departmental projects and goals.
Create and maintain Policies for the UM/Care Management Departments
Create and maintain Documentation of processes to maintain URAC accreditation and Medicare regulations
Responsible for the running or participating in the Delegation Committee.
Provide and/or monitor and audit all evidence provided by the vendors to ensure complete and gaps are closed.

Fulltime

Health Pro

As a Health Pro, you can expect the following: When you start, you will receive ...

Location

United States of America , Virtual

Salary:

50000.00 USD / Year

Alight Solutions

Expiration Date

Until further notice

Requirements

2 years billing/insurance experience, or 3 years’ experience in a billing/insurance/benefits related role
Ability to work effectively in a remote team environment
Strong problem solving, critical thinking, and analytical skills – ability to comprehend a member’s needs and determine the steps required to complete their request
Exceptional written communication skills – can convey complex concepts in writing for members that are not benefits experts
Strong ability and desire to learn continually in a changing environment
Ability to efficiently organize work activities to meet deadlines
Passion to provide the highest level of client satisfaction
Ability to receive and immediately apply constructive feedback
Proficiency in MS Office suite

Job Responsibility

Be an advocate for members requiring guidance across the health benefits environment by helping them navigate questions about their benefits, identify the highest quality and cost-effective providers, understand benefit claims, and be an advocate for the employee across the health ecosystem
Gather a full understanding of the members’ needs and own the resolution of the customer’s request
Gathering information about the reason the customer is seeking support or care
Educating members on benefit programs provided by clients
Translating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand and use
Delivering provider recommendations, referral guidance, and connections to clinical or employer‑sponsored programs to support informed care decisions
Completing cost estimates and communicating out‑of‑pocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelines
Explaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available cost‑saving opportunities
Proactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resources
Connecting members to company sponsored health and benefits programs for specialized care

What we offer

Health, dental and vision coverages starting Day One
Wellbeing programs
Retirement plans with contribution matching
Generous time off
Parental leave
Continuing education
Career growth opportunities
Flexible working arrangements

Fulltime

Medical Services Coordinator – Prior Authorizations

The Medical Services Coordinator serves as a key support resource for psychiatri...

Location

United States , Edmond

Salary:

21.00 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience with medical prior authorizations strongly preferred
Experience in healthcare, behavioral health, medical office, or insurance coordination preferred
Strong attention to detail and ability to manage multiple authorization requests simultaneously
Comfortable communicating with insurance carriers and clinical staff
Proficient in Microsoft Office and EMR systems
Strong written and verbal communication skills
Ability to work independently in a structured, fast-paced environment

Job Responsibility

Initiate, submit, and track prior authorization requests for medications, psychiatric services, and related treatments
Communicate directly with insurance companies to obtain approvals, resolve denials, and follow up on pending requests
Ensure all required clinical documentation is complete, accurate, and submitted within required timeframes
Collaborate with psychiatric clinicians to obtain supporting medical necessity documentation
Monitor authorization status and proactively address delays to prevent interruptions in patient care
Maintain accurate documentation of all authorization activity within the Electronic Medical Record (EMR) system
Track approvals, expirations, and reauthorization requirements
Assist with appeals processes for denied prior authorizations
Provide administrative support to clinicians, including faxing, scanning, and documentation assistance
Coordinate with pharmacies regarding medication access issues

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Vice President of Clinical Reimbursement / MDS

Vice President of Clinical Reimbursement / MDS at Azria Health. Azria Health is ...

Location

United States , Des Moines

Salary:

Not provided

Azria Health Longview

Expiration Date

Until further notice

Requirements

Active RN license required
multistate licensure preferred
Minimum of 5 years of experience in long-term care reimbursement and MDS leadership
Multi-facility oversight experience strongly preferred
Extensive knowledge of PDPM, Medicare, Medicaid, OBRA regulations, and CMS guidelines
Proven ability to analyze financial and clinical data to drive operational outcomes
Strong leadership, communication, organizational, and problem-solving skills
Ability to travel regularly throughout Iowa and Kansas facilities
RAC-CT, RAC-CTA, or other reimbursement-related certifications preferred

Job Responsibility

Provide strategic oversight and leadership for all MDS and clinical reimbursement operations across multiple skilled nursing facilities
Ensure accuracy, timeliness, and compliance of MDS assessments and reimbursement processes
Lead and support regional and facility MDS coordinators and reimbursement teams
Monitor and optimize Medicare and Medicaid reimbursement performance under PDPM and state-specific reimbursement methodologies
Analyze reimbursement trends, case mix indices, quality measures, and financial outcomes to identify opportunities for improvement
Develop and implement policies, procedures, and best practices related to clinical reimbursement and MDS operations
Ensure compliance with all federal and state regulations, CMS guidelines, and company standards
Partner with clinical, operational, and financial leadership to improve documentation accuracy and reimbursement integrity
Conduct audits and provide education, training, and mentorship to facility teams
Assist facilities during surveys, audits, appeals, and regulatory reviews related to reimbursement and documentation

What we offer

Health, dental, and vision insurance
Paid time off
Retirement plan options
Professional development opportunities
Supportive and collaborative leadership environment

Fulltime

Genetic Counseling Assistant I- Neurology

Join licensed genetic counselors in a growing Neurogenetics Program with special...

Location

United States , Brookline

Salary:

21.47 - 33.55 USD / Hour

Boston Children's Hospital

Expiration Date

Until further notice

Requirements

Bachelor’s degree, preferably in Biological Science, Clinical Laboratory Science or related scientific field, Advocacy and Social Sciences
One year of experience in a laboratory setting or healthcare, public service or insurance customer service setting is preferred
Spanish fluency preferred
Ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations
Ability to gather and synthesize data, resources, and literature related to relevant genes, variants, diagnoses and test results
Ability to demonstrate professional behavior by adhering to departmental and organizational policies and procedures, and assuming authority appropriately
Analytical skills and judgment to interpret data and take the appropriate action in circumstances or situations that vary

Job Responsibility

Triages genetic counseling referrals, phone calls, and emails, coordinating with program PER and schedulers to ensure timely and accurate patient scheduling
Performs pre-visit preparation, including collecting medical records, lab reports, estimates, and intake forms
Responds to post-visit questions regarding genetic testing and sample status
escalates genetic counseling questions to the appropriate Genetic Counselor (GC)
Assists with obtaining consent from additional family members under supervision
Coordinates genetic testing logistics, including identifying laboratories, researching submission requirements, arranging shipment of testing kits, and submitting required medical records
Tracks genetic testing samples and follows up on missing samples, documentation, or patient information with patients, GCs, laboratories, and providers
Submits and tracks prior authorizations and appeals, including letters of medical necessity, supporting clinical documentation, CPT/ICD-10 coding, and peer-to-peer coordination with insurance providers
Completes genetic testing requisition forms, including review of pedigrees and assignment of diagnosis codes
Maintains patient testing databases and ensures results are accurately entered into program systems

What we offer

flexible schedules
affordable health, vision and dental insurance
child care and student loan subsidies
generous levels of time off
403(b) Retirement Savings plan
Pension
Tuition and certain License and Certification Reimbursement
cell phone plan discounts
discounted rates on T-passes

Fulltime

Physician Support Rep III-Imaging Scheduling Operations

As a community, the University of Rochester is defined by a deep commitment to M...

Location

United States , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

High School diploma and 2 years of relevant experience required
Or equivalent combination of education and experience

Job Responsibility

Performs complex secretarial and administrative duties in a fast-paced environment supporting clinical, educational, and academic programs
Responsible for all clinic preparations, including but not limited to providers' time and calendar management while optimizing provider-patient schedule, coordination of patient care, and information/data support
Serves as primary contact for provider(s)
Manages provider(s) calendar and prioritizes appointments and meetings based on provider preferences
Chooses and recommends among competing demands
Examines the clinical schedule(s) on a continuous basis to identify opportunities for optimizing the time and effort of providers
Finds missing orders and sends them for review and approval
Anticipates needs of insurance companies by gathering all necessary information for referrals and prior authorizations
Applies provider preferences and protocols in selecting multiple possibilities to execute and/or delegate follow-up actions based on the provider’s patient notes
Composes, edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims, including compiling all necessary information and drafts for provider signature

Fulltime

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Clinical Appeals Coordinator

Job Description

Job Responsibility

Requirements

What we offer

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