Appeal Resolution Manager jobs in Ohio

Appeal Resolution Manager manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed medical, insurance, and other claims. Oversees work activity that is compliant with all regulatory guidelines and policy protocols. Being an Appeal Resolution Manager allocates team resources to ensure an effective and balanced case workload. Applies industry standards and uses best practices in the preparation of legal briefs. Additionally, Appeal Resolution Manager may represent the organization at hearings. Requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. The Appeal Resolution Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be an Appeal Resolution Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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STRATEGIC APPEAL SPECIALIST-Financial Clearance Center
  • METROHEALTH MEDICAL CENTER
  • Cleveland, OH FULL_TIME
  • Location: METROHEALTH MEDICAL CENTER

    Biweekly Hours: 80.00

    Shift: 8:00am-4:30pm


    The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.


    S ummary:

    Processes both inpatient and outpatient denials and appeals while following departmental and federal/state/other regulatory agencies’ requirements. Follows up on internal and external status inquiries. Produces/distributes denial and appeal statistics through regular reporting. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.


    Qualifications:
    Required:
    Meets one of the following:
    • Associates degree from an accredited institution.
    • 3 years of hands-on experience with processing and/or following up on insurance denials and appeals will be accepted in lieu of a degree.
    Strong PC skills.
    Experience with and/or a strong understanding of managed care information systems.
    Strong written, verbal, and interpersonal communication skills.
    Solid organizational skills.
    Ability to work independently, and in a team environment.
    Ability to work with a high degree of flexibility.

    Preferred:
    Experience with Epic.
    Experience using MIDAS products.

    Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to communicate in face-to-face, phone, email, and other communications. Ability to see computer monitor and departmental documents.
  • 25 Days Ago

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Account Resolution - Legal Collector
  • Weltman, Weinberg & Reis Co., LPA
  • Brooklyn, OH FULL_TIME
  • $2k Retention Bonus during your 1st year of Employment! Are you looking to start your career in the Legal field or continue a career in customer service? We are currently seeking a Legal Account Resol...
  • 14 Days Ago

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Customer Resolution Specialist
  • Advanced Drainage Systems
  • Findlay, OH OTHER
  • Overview At ADS, no idea is off limits, and we celebrate creativity and bold moves. For more than 50 years ADS has been manufacturing a variety of innovative and environmentally friendly alternatives ...
  • 6 Days Ago

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Asset Resolution Paralegal - Cleveland
  • World Business Lenders, LLC
  • Cleveland, OH FULL_TIME
  • About World Business Lenders (www.wbl.com)World Business Lenders (WBL) provides general purpose short-term real estate collateralized commercial loans to a broad customer base comprised of small and m...
  • 8 Days Ago

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Claims Resolution Analyst
  • Acosta Group
  • Cincinnati, OH FULL_TIME
  • **Overview** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be responsible for analyzing claims and mak...
  • 1 Month Ago

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Consumer Resolution Specialist
  • Unifund CCR, LLC
  • Cincinnati, OH FULL_TIME
  • Overview: The Consumer Support specialist is responsible for handling inbound and outbound consumer calls, consumer emails, as well as other inquiries including but not limited to administrative consu...
  • 24 Days Ago

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Policy Search Analyst
  • Resolute Management Inc.
  • Boston, MA
  • Resolute Management, Inc. is a Third-Party Administrator hired by clients to handle complex environmental, asbestos, and...
  • 4/19/2024 12:00:00 AM

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Contentful Sr. Support Engineer - L2
  • eTeam, Inc.
  • Boston, MA
  • Should have eCommerce background, Contentful •5+ years of experience in digital marketing and atleast 3 years of experie...
  • 4/19/2024 12:00:00 AM

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Associate Attorney
  • Donaldson Stewart, PC
  • Chandler, AZ
  • Donaldson Stewart, PC is seeking a Family Law Attorney to join our Chandler, Arizona team. If you or someone you know ma...
  • 4/18/2024 12:00:00 AM

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Personal Injury Attorney
  • Rob Levine Law
  • Myrtle Point, OR
  • Personal Injury Attorney in RI, MA - Remote Position - Great Base Pay and Training Are you ready to take your career and...
  • 4/17/2024 12:00:00 AM

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Legal Intern
  • Prinston Pharmaceutical Inc.
  • Somerset, NJ
  • Job description Prinston Pharmaceutical Inc. ABOUT US Prinston Pharmaceutical, Inc. is a fully integrated pharmaceutical...
  • 4/17/2024 12:00:00 AM

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Associate Attorney
  • Donaldson Stewart Pc
  • Chandler, AZ
  • Donaldson Stewart, PC is seeking a Family Law Attorney to join our Chandler, Arizona team. If you or someone you know ma...
  • 4/16/2024 12:00:00 AM

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Litigation Associate
  • Honcho Executive Search Group, LLC
  • Honcho, acting as the search firm on behalf of an East Coast based law firm is currently seeking a Civil Litigation Atto...
  • 4/15/2024 12:00:00 AM

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General Counsel
  • Gotham Technology Group
  • Montvale, NJ
  • We are a privately held technology consulting firm with 20+ years of solid performance and growth. We service corporate ...
  • 4/15/2024 12:00:00 AM

Ohio /oʊˈhaɪoʊ/ (listen) is a Midwestern state in the Great Lakes region of the United States. Of the fifty states, it is the 34th largest by area, the seventh most populous, and the tenth most densely populated. The state's capital and largest city is Columbus. The state takes its name from the Ohio River, whose name in turn originated from the Seneca word ohiːyo', meaning "good river", "great river" or "large creek". Partitioned from the Northwest Territory, Ohio was the 17th state admitted to the Union on March 1, 1803, and the first under the Northwest Ordinance. Ohio is historically know...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Appeal Resolution Manager jobs
$91,497 to $118,912

Appeal Resolution Manager in Bergenfield, NJ
The appeals conference is an informal meeting in which an impartial officer settles the dispute in the same way a judge does between a plaintiff and defendant in court.
January 01, 2020
Appeal Resolution Manager in Concord, NH
A number of local governments have already passed the resolutions and others are expected to consider the measures.
January 04, 2020
Appeal Resolution Manager in Appleton, WI
If your tax return was recently under examination and you received written notification of an adjustment the IRS is making to your tax return, such as disallowing a deduction or credit, you have the right to disagree and the right to appeal its decision.
December 23, 2019