Appeals Referee Job Description Samples

Results for the star of Appeals Referee

Soccer & Football Referee

Fulton Parks & Recreation is currently accepting applications for the following part-time, temporary positions: Flag Football Referee Flag Football referees should have 1- 2 years officiating experience at the Parks & Recreation or University level.
Referees must be willing and able to attend the mandatory training clinic.
Application Deadline: September 1st Soccer Referee Soccer referees should have 1-2 years officiating experience at the Parks & Recreation, high school or university level.
Missouri State High School Activities Association registered officials are preferred.
Referees must be willing and able to attend the mandatory training clinic.
Application Deadline: September 1st Event Supervisor (1 position available) Event Supervisors are responsible for assisting with the administration of a variety of Parks & Recreation youth and adult athletic events.
Duties include, but are not limited to: Event organization, set-up, supervision and evaluation, scorekeeping, and evaluation of game officials.
Knowledge of a variety of sports and a strong desire to work in a challenging and fun environment is required.
For all positions listed above, you must be willing and have the ability to work nights & weekends as required.
A valid Drivers License and reliable transportation is also required.
Hours will vary depending on the activity.

Apply in person at

Fulton City Hall, 18 East 4th Street or on - line at .
EOE. Application Deadline: September 1st Category: Sports , Keywords: Umpire / Referee


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Appeals Nurse

About us:
Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates.   We are created and managed by experienced industry professionals in healthcare. As a leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.
Open Position:
We are currently recruiting for an Appeals/ Utilization Review Nurse.  We are seeking candidates with a strong ability to generate appeals letters along with conducting complete medical review against national care criteria.
REQUIREMENTS:

  • Active Michigan RN / LPN or LVN
  • Associate Degree or Bachelor Degree in Nursing
  • Must have experience in appeals and writing appeal letters
  • Strong knowledge and understanding of Milliman Care Guidelines criteria and use of evidence based medical protocols
For
More Information:

Visit www.morganstephens.com
Twitter: www.twitter.com/morganstephens0
Instagram: www.instagram.com/morganstephens0/
Facebook: www.facebook.com/MorganStephens0
Email: info@morganstephens.com
Morgan Stephens ofrecemos reclutadores que hablan Espanol

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Referee Internship (Fall 2017)

REFEREE INTERNSHIP - FALL2017 - USA RUGBY, LAFAYETTE, CO Term: Full or Part time, September through December Compensation:

Unpaid, College Credit USA Rugby is the national governing body for the sport of rugby in America, and a Full Sport Member of the United States Olympic Committee (USOC) and World Rugby. Currently headquartered in Lafayette, Colorado, USA Rugby is charged with developing the game on all levels and has over 115,000 active members. USA Rugby oversees four national teams, multiple collegiate and high school All-American sides, and an emerging Olympic development pathway for elite athletes.

We are currently seeking to fill the position of Referee Internship. Overview: The primary focus of this internship is to support and assist in the management of programs related to increasing the participation in rugby officiating on all levels in the USA. The Referee Intern will assist with research and development of events, logistical planning of events, work with existing programs, research and develop new initiatives, and other tasks that contribute to the growth of officiating in the United States.

Responsibilities include: Assist in the creation of tournament documents, event information packets, and staff compensation. Support Referee Department staff in the development, logistics, and management of events such as tournaments, camps, clinics, and educator workshops.

Assist in the creation of promotional materials for referee outreach Assist in the creation of other game development materials used by referees, coaches, players and volunteers to start new programs and improve those already in existence Assist with the moderation of referee groups on social media platforms Office administrative tasks such as mailing, inventory, data entry, etc. Respond to referee development inquiries and provide information and resources as requested Other duties as assigned Percentage of duties: 15%- Customer service by, email, phone and in person contact 40%- Website, marketing and mass communication development 30%- Event and initiative support 15%- All other duties assigned Interns should possess a passion for sport development, strong customer service and interpersonal skills. Posted by StartWire



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Mgr Grievances & Appeals

Job ID 52106

Category: Other

Location: Newark, NJ

Experience: 3 to 5 years

Posted: 8/8/2017

Education: See Requirements

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Manager, Denials and Appeals to join our team in Newark, NJ.The Denials and Appeals Manager will have overall responsibility to achieve operational business goals as is related to managing denials and appeals according to State, Federal laws, regulations and mandates and NCQA/URAC accreditation. The Manager builds customer loyalty by developing, motivating and retaining a committed staff of Appeal Coordinators, who deliver high quality, cost effective member and provider services.

Position Responsibilities:

  • Manage clinical appeals; administrative and executive complaint resolution; legal and regulatory inquiry resolution

  • Maintain policies and procedures, SOPs, process flows and correspondence templates; support internal and external audits and the coordination of regulatory and client audit related activities.

  • Assure compliance with all state and federal laws, regulatory requirements, accrediting agencies (NCQA and URAC) as well as Beacon Health Options corporate policies and procedures.

  • Responsible for meeting and exceeding targeted performance guarantees (PG) stipulated within client agreement

  • Accountable for management of departmental inventory and work allocation assignments to staff

  • Generate and delivery client reporting related to key performance indicators, internal and external production reports, and quality management reports

  • Manage production and quality standards among Coordinators and Quality Specialist

  • Provide daily oversight to the supervision of personnel, which includes work allocations, schedules, ensure employee education and training including building employee knowledge, skills and capabilities required to perform in their job function that will contribute to improved performance

  • Manage and adjust quality audit programs to support the department's objectives, including corrective action plans.

  • Make recommendations for personnel actions and approve motivational plans and/or programs for individual or team performance

  • Additional management responsibilities or projects assigned by leadership

Position Requirements:

Education: Bachelor's degree in Business Management, Allied Behavioral Health, Healthcare Management or related degree; Master's preferred

Licensure: MSW, MFT, LPC, RN preferred

Relevant Work Experience: A minimum of 3-5 years' general operations and appeal management experience in the health care industry

Knowledge, Skills & Abilities:

  • Extensive knowledge and understanding of business systems that include client service and mainframe applications as well as computer literacy and management information systems are required.

  • Knowledge of and ability to understand medical terminology and health insurance regulations

  • Ability to research and solve problems with minimal supervision

TO APPLY

Click below on"Apply for this Position"to create a profile and apply for the position. Beacon Health Optionsis proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

$NFD

#CB

PM16

Job Requirements

PI98988120


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Medical Insurance Appeals Specialist

Job Description

Seeking experienced part time (25-29 hrs/wk) insurance appeals specialist for busy surgeon's office in Centerville. Must know CPT and ICD9-10 coding.  Must be a fast leaner, self motivated team player with pleasant attitude and professional appearance. Please send resume for prompt consideration.

Company Description

Busy 3 physician office with Medicare approved AAAA Surgery Center on site. All physicians are Board Certified in Plastic Surgery.

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Court Criminal Appeals Clerk - Administrative Assistant III

Multiple positions may be filled from this announcement.Position is part of the Case Processing Section of the Criminal Division of the Circuit Court. Under general supervision performs a wide range of duties in processing criminal cases.

Must possess good time management, have strong attention to detail and exceptional customer service skills.

All criminal processing transactions must be accurate and performed in a timely manner in order to meet mandated deadlines. Duties include but are not limited to:

Responsible for the preparation of various case types within the Criminal Division Routinely interact with judges, Commonwealth's Attorneys, the Districts Courts, the sheriff's department and defense attorneys. Performs a variety of functions as required by specific documents, cases, or judgments using the court case management system. Processes felony cases, misdemeanor and traffic infraction appeals, juvenile appeals, court orders, and search warrants.

Functions as a customer service representative for the Criminal Division on the phone, in person, and through correspondence. Maintains, initiates, updates, and manages case files, both electronic and paper for use by the public, staff, judges, lawyers, and other county and state agencies. Performs related duties as required

This is an entry level position and salary offer for the position will not exceed the mid-point of the advertised salary range.

Employment Standards

MINIMUM QUALIFICATIONS:Any combination of education, experience and training equivalent to high school graduation and two years of experience providing administrative support in the assigned functional area(s).NECESSARY SPECIAL REQUIREMENTS:The appointee to this position will be required to complete a criminal background check to the satisfaction of the employer.PREFERRED QUALIFICATIONS: Associate's degree Three to four years' of experience performing administrative work.

Three to four years' of experience in a court or legal environment. Exceptional attention to detail, exercise tact, discretion, initiative, and independent judgment. Excellent communication and customer service skills.

Ability to perform multiple complex tasks simultaneously in a high-volume environment as well as handle sensitive information while maintaining confidentiality. Must be able to work independently and in a team environment. Ability to develop and monitor Excel spreadsheets to track information and statistics.

Experience in the use of Microsoft Office computer software, especially Word, Outlook, and Excel.PHYSICAL REQUIREMENTS:Requires ability to lift boxes, file and push a cart weighing up to 20 pounds. Ability to input and retrieve data from a computer. Must be able to type at least 30 wpm due to high volume of legal documents.

Physical requirements can be performed with or without reasonable accommodations.SELECTION PROCEDURE:Panel interview. As part of the interview process you may have to complete a written exercise, that is a writing sample. You will be provided with a short question/subject and are required to type your response within 30 minutes on the computer.

It is the policy of Fairfax County Government to prohibit discrimination on the basis of race, sex, color, national origin, religion, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. Contact 703-324-4900 for assistance. TTY 711. EEO/AA/TTY.



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Appeals & Grievance Coordinator

Grievances and Appeals Coordinators serve as a single point of contact to provide support and advocacy to health plan members for resolution of grievances.

Basic Qualifications:

  • Minimum of one year of recent experience as an Appeals and Grievances Coordinator.
  • Strong computer and telephone multitasking skills including: the ability to effectively search for and type information on the computer, navigate through multiple windows and screens quickly, and inputting information accurately while keeping pace with the call
  • Requires excellent verbal and written communication skills
  • Excellent analytical and problem-solving skills with the ability to make independent decisions. 
  • Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
  • Ability to remain focused and productive each day though tasks may be repetitive

Responsibilities:
  • Receives member complaints via telephone and/or written correspondence then categorizes the member complaint as a grievance, appeal, or inquiry as defined by CMS, if it is for a Medicare/Medicaid claim
  • Coordinate the overall grievance resolution process by evaluating and resolving oral and/or written complaints from members in compliance with federal, state, and organizational grievance procedure guidelines
  • Communicate decisions to members verbally or through written correspondence to close the grievance in a timely and accurate manner
Preferred Qualifcations:
  • Previous successful work at home experience

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Flag Football Referee [Southside, Monroeville And North Park]

We are currently looking for athletic and "up beat" individuals to become dedicated members of our staff by providing outstanding officiating for our youth and adult flag football games. Our adult league participates in a 4 on 4 format while the youth league is 5 on 5. Both styles of play tend to be fast paced in nature, therefore any applicant should be prepared to move in a high tempo pace.

  • Prior referee or stat keeper experience is not required.
  • Availability on Sundays between 8:00am and 3:00pm starting in September is a must.
  • Professionalism, punctuality, and a willingness to assert control is what we are looking for.
  • Special consideration will be given for former flag football players.

Requirements

  • 18yrs or older with reliable transportation.
  • Excellent oral communication skills with a passion for working with children and/or adults in a sports setting.
  • Be able to collaborate and consistently perform as a “team player” with other staff members.
  • Willing to participate in on-field and classroom training.

Benefits

Compensation: $13 - $15 per hr based on experience and performance during the assessment training.

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RN Appeals Analyst (Registered Nurse)

  • Reviews provider appeal and medical documentation.
  • Reviews form CMS-1500 or equivalent electronic counterpart for proper coding.
  • Accesses Legacy or Diamond to review how the claim was originally processed by the Company.
  • Assist appeal coordinators in the clinical research and processing of appeals in accordance with Employee Retirement Income Security Act (ERISA), Health Insurance Portability and Accountability Act (HIPAA), and corporate/departmental standards.
  • Interpret Company's Medical Coverage Guidelines for staff.Collaborate with Managing Medical Director to facilitate changes to the Company's Medical Coverage guidelines.
  • Responsible for research, preparation, and presentation of clinical appeal cases (medical necessity and experimental/investigational procedures) to the Provider Appeal Panel.
  • Works with business partners across the organization, as needed, to gather data as input for final determination.
  • Follows regulatory requirements as appropriate and corporate values, policies and procedures.
  • Ensures final determination is reached and communicated to the provider within strict timelines.

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Appeals Sr Associate With Cigna

You may also apply directly at: http://tennesseeinterviews.com/job/appeals-sr-associate-with-cigna/
The position listed below is not with Tennessee Interviews but with CIGNATennessee Interviews is a private organization that works in collaboration with government agencies to promote emerging careers. Our goal is to connect you with supportive resources to supplement your skills in order to attain your dream career. Tennessee Interviews has also partnered with industry leading consultants & training providers that can assist during your career transition. We look forward to helping you reach your career goals! If you any questions please visit our contact page to connect with us directlyUpdates appeals tracking system, consults with Appeals Analyst Specialist regarding technical claims issues; determines required expert resources at each juncture and solicits input. Based on appeal investigation, determines whether claim is reopened or original denial was appropriate. Proactively communicated with claimants, employers, providers and the original case manager to resolve investigation issues and communicate decisions/rationale for denial/approval.
* Responsible for maintaining timeliness of effectuations and overturns decision notification.
* Works closely with the reviewers to communicate status variances.
* Serves as a communication bridge between Appeals and the Claims department.
* Prepare, send IRE packets, and track the IRE process through to completion.
* Review and validate the accuracy of the Reviewers data entry and supporting documentation.
* Periodically, review and ensure timely completion of appeals investigation and fairness of administrative decisions. This role requires the ability to consistently apply appropriate administrative and regulatory criteria.
* At times, the role will require effective communication of guidelines to the Medical Director. This has a direct impact on the Fairness of Decision Star measure (IRE upholds).
* Respond to telephonic Appeal Status Inquiries
Requires more than 2 years'experience in billing, claims, customer service or health insurance; familiarity with state and federal regulations, medical terminology and coding.
US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at ...@cigna.com.

Posted by StartWire

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