Appeals Referee Job Description Samples

Results for the star of Appeals Referee

Adult Soccer Referee

Adult Soccer Referee - $25.00 per hour - 8 Positions.Position runs from April to the middle of May (Soccer season, April 3, 2017 - May 15, 2017). Referees are responsible for providing a positive and safe environment for Adult Soccer recreation games. Applicants must possess excellent communication skills, energetic personalities and the ability to work patiently with participants.

This position requires applicants with a working knowledge of the rules of soccer and at least three (3) years of playing experience. Referees must have the ability to interpret and enforce the rules of soccer and must be able to physically keep up with the speed of play.Equal Opportunity Employer.



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Youth Sports Official / Referee Asheville

Description Under the direction and guidance of the Program Director and consistent with the mission of the YMCA and the policies and guidelines of the YMCA of Western North Carolina, the Sports Official position is responsible for the integral part of monitoring sports activity, making sure all rules are followed and the game is played fairly. Qualifications

Qualifications: Sports Official/Referee must be able to: * Have an enthusiastic personality and ability to develop harmonious relationships with staff, parents, participants and school faculty.

  • Have a general understanding of sports, rules of the game and have a strong interest working with youth ages 7-12.Physically perform all CPR and First Aid skills.

  • Assist as needed in emergency situations.

  • Move to various locations in and around the entire facility.

  • Bend or stoop and reach to various height levels.

  • Hear noises and distress signals.

  • Demonstrate basic computer skills and competently enter data into the DAXKO computer system.

  • Display strong interpersonal skills including communication (verbal and written), decision making, and conflict resolution. * * * Sports Official/Referee must be a high school graduate, with previous experience in sport of work. He/She must hold and maintain current certifications in the following: * CPR (including adult, infant, child, and two-rescuer) * Community First Aid, including Bloodborne Pathogen Certification

  • Automated External Defibrillation (AED) * Child Abuse Prevention * YMCA Working With Series (preferred) * YMCA Asset Development (preferred) *All required certifications must be obtained within 90 days of employment. * * *

Essential Functions: The Sports Official/Referee must: * Know and understand all YMCA policies and procedures, and ensure that all these procedures are always consistently enforced.

  • Assist as needed in emergency situations and as outlined in emergency procedures.

  • Continuously exhibit honesty, caring, respect, responsibility, reliability, flexibility, maturity, and good decision-making skills.

  • Display a professional, courteous, and tactful demeanor at all times. Always strive to display a positive and enthusiastic attitude.

  • Enforce the rules of the game.

  • Arrive at least 15 minutes prior to your first game scheduled.

  • Complete score sheets at score table. Write in final score, circle winning team, initial games officiated.

  • Facilitate/lead sports discussion with coaches/captains before game.

  • Ensure game starts on time.

  • Take charge. Do not be afraid to blow the whistle.

  • Explain your calls to players and coaches.

  • Ensure safety.

  • Actively engage with coaches. Always explain to the coaches how the game will be called.

  • Ensure goal heights are adjusted according to age division and proper size ball is used.

  • Assist supervisor with set-up/clean-up as needed.

  • Maintain control of game. Keep composure under pressure. Help keep a positive environment. Do not allow coaches or parents to argue with you.

  • Attend all staff meetings and trainings as required.

  • Assist in the identification of active volunteers for the Annual Campaign.

  • Promote and represent the mission and core values of the YMCA of WNC * All other duties assigned by Management. * * *

Effect on End Results: Proper performance of the essential functions of the YMCA Sports Coordinator will result in: * Steady growth in sports programming and participation * YMCA Character Development evidenced in all sports programs.

  • Well maintained, quality YMCA programs driven by input from patrons.

  • Positive and constructive evaluations and feedback (written and oral) from supervisors, members, and program participants.

  • Overall safe, productive, and effective YMCA programs. * * * The YMCA of Western North Carolina is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to sex, race, color, age, creed, national origin, religion, disability, veteran status, uniformed service member, genetic information, or any other category protected by applicable federal, state, or local laws, regulations or ordinances. No question on our application is intended to secure information to be used for such discrimination. Testing of job-related skills may be required prior to employment.

Level: Experienced Job Location: USA [NC, Asheville] Position Type: Seasonal Part-time Hourly (Non-exempt) Education Level: Not Specified Salary Range: $9.70 - $18.90 Hourly Travel Percentage: Undisclosed Job Shift: Hours Vary Job Category: Training


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Unemployment Insurance Referee - Gr.25 - Brooklyn (Two Vacancies)

Minimum QualificationsMINIMUM QUALIFICATIONS Note: If you are on the examination eligible list for the position title in this location, you do not need to respond to this posting unless you are also eligible for appointment by one of the qualifications listed below.

Reassignment Qualifications: An NYS Department of Labor employee with one year of permanent competitive service as an Unemployment Insurance Referee, Grade 25 is eligible for reassignment to any location where a vacancy exists in the title. Transfer Qualifications:

This position is designated as administrative and may be filled via administrative transfer under Section 52.6 of the Civil Service Law, provided that all transfer criteria are met. Source titles from which transfer may be made must be designated administrative and be Grade 23 or above. Transfer candidates must also possess a law degree from an accredited college or university.

Admission to the New York State Bar and current registration to practice Law in New York State is necessary for continued employment. Disbarment or loss of registration shall result in termination or suspension of employment. Duties DescriptionStandard Duties:

When assigned to the Hearings Section, Unemployment Insurance Referees are responsible for conducting hearings, evaluating factual information and rendering written decisions, in accordance with the New York State Unemployment Insurance Law, related statutes, and special Federal programs, for claimants or employers appealing initial determinations regarding entitlement to unemployment insurance compensation or liability for unemployment insurance contributions. If assigned to the Appeals Section, Unemployment Insurance Referees review and analyze records and files for cases on appeal, prepare summaries of such cases, and author appeal decisions for the Board. Additional CommentsAccepting 55b/55c Candidates.

Please provide a copy of your 55b/55c letter when applying. Travel Requirements: Occasional Some positions may require additional credentials or a background check to verify your identity.

Agency: Labor, Department of Title: Unemployment Insurance Referee - Gr.25 - Brooklyn (Two Vacancies) Occupational Category: Legal Salary Grade: 25 Bargaining Unit: PS&T; - Professional, Scientific, and Technical (PEF) Salary Range: From $79849 to $100645 Annually Employment Type: Full-Time Appointment Type: Permanent Jurisdictional Class: Competitive Class Travel Percentage: 0%



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Referee

Basketball Referees Needed

We are now accepting applications for the following positions * Coach / Referee * * * Coach / Referee : Middle SchoolThe Youth Sports Coach / Referee is responsible for the instruction, supervision and officiating of the following sports: Flag Football, Volleyball, Soccer and Basketball. The Coach / Referee will work to maintain a positive environment for everyone involved by: ensuring games start on time, keeping players safe, officiating games, interacting regularly with players, parents, volunteers and staff.

  • Keeps participants, coaches and parents informed at all times (scorekeepers). * Enforces Game rules and regulations.

  • Checks players for proper uniform and equipment.

  • Follows, administers and implements THINK Togethers policies and guidelines. * * *

Requirements: * Experience working with young children and the ability to inspire and motivate. * NCLB Compliance (completion of 48 college units or have Instructional Aide Certificate or by passing THINK Together's Pre Employment Test (district specific)) * Ability to speak and write standard English appropriate in a public school setting.

  • Must clear TB and Fingerprint check. * * *

Hours: * MUST be available at least 3 days a week (5 preferred), Monday - Friday (2:00 and 6:00pm).. * * *

Pay: * $11/Hour * * * THINK Together is in search of outstanding individuals from all backgrounds, majors, and career interests. If you think you are ready to shape the lives of students, build relationships with families, provide students with the foundational knowledge, skills and mindset to pursue their dreams and become successful leaders, we invite you to apply.

Worker Category: Part-Time Posted On: 02/22/2016 Requisition ID: 1065 Salary Range: 11.0000-11.0000 (USD) Hourly Job Class: Service Workers


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Youth Sports Referee

We are looking for high energy, fun, reliable, and service-oriented people to officiate Flag Football and Soccer games in Shoreline, Lynnwood, Everett, Snohomish, and Marysville beginning this Spring. All games are on Sunday afternoons. Previous experience is a plus, but not required. Training will be provided. Pay is $17 per game, with games lasting no more than an hour. Ref 3-5 games in a day.

Requirements:

  • Enjoy working with kids

  • Be fun, energetic, and enthusiastic

  • Be confident and capable of dealing with parents and upholding the i9 Sports philosophy

  • Reliable transportation to and from games and training

  • Clean background check

  • Be at least 18 years of age.

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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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Manager, Denials & Appeals (Rn) – Austin

Manager, Denials & Appeals (RN) – Austin
Joining this team means you'll be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. The group is a fast, agile, customer-focused organization with a commitment to implementing the latest technologies. If these same things get you excited, we hope to hear from you.
Position Purpose: Ensure appropriate processing of member denials and appeals, provider appeals that require clinical review, and/ or State Fair Hearings. Perform duties as the point of contact with the State.

Job Description:

  • Ensure that all denials and appeals are processed in accordance with Federal, State and NCQA time frames and other contractual legal requirements
  • Identify trends within denials and appeals and provide results to internal committees, CMS and the State as required by contract
  • Serve as the point of contact for any issues or questions related to denials and appeals for various external agencies, including state, local and federal governments, local community and the public
  • Integrate federal and state law changes to denials and appeals into company's regulatory system
  • Recommend solutions and ensure issues are corrected and corrective measures are implemented to prevent recurrences
  • May provide training and direction to agencies in developing procedures to comply with denials and appeals requirements

Qualifications:

Education/Experience:
  • Bachelor's degree in Nursing or related clinical field or equivalent experience.
  • 3+ years of utilization management, quality improvement or denials and appeals experience.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • Managed care, healthcare law or compliance experience preferred.
Licenses/Certifications:
  • Texas RN (Registered Nurse)
Our client offers options that allow you to do more than just plan for retirement. Their programs allow shared success with employees.
  • 401(k) with company match
  • Employee stock purchase plan
  • Training and Learning Opportunities/Tuition Reimbursement/Educational Assistance
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
Equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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Appeals Management Analyst

Appeals Management Analyst + Analyze new denials including + Review third party correspondence + Reassign cases that don’t require clinical intervention to Patient Accounting + Refer potential IP-AMS re-bills to the Assistant Director, Clinical Data Management (ie registration errors) + Obtain formal denial letters if possible + Verify Appeal addresses + Assign risk amount + Maintains documentation on denied cases in EPIC based on findings obtained during telephonic discussion with third party payers + Identify denial trends and report them to the Assistant Director, Clinical Data Management for follow-up + Request medical records and follow-up on outstanding requests + Maintain appeals correspondence file + Prepare cases for Appeals Manager upon receipt of medical record + Assist Appeals Manager with mailings + Communicate findings with Patient Accounting and Finance + Refer closed cases to the Assistant Director, Clinical Data Management for further analysis + Provide assistance in the day to day administrative duties for the appeals management program Requirements + Associates Degree required - Bachelors Degree highly desirable + Minimum 2 to 3 years experience with hospital revenue cycle; Inpatient and Outpatient Billing; experience with denials/appeals management highly desirable + Proficient with Microsoft; Eagle; Epic; Allscripts Care Management; Database management + Good customer service skills; attention to detail; flexible; ability to multi-task; Critical thinking ability #LI-JL1 ID: 2017-8739 Hours per Week: 35 Shift: Days External Company Name: Hospital for Special Surgery External Company URL: www.hss.edu


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Grievance & Appeals Coordinator I

Description: Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail

Qualifications: Education/Experience: High school diploma or equivalent.
Associate s degree preferred. 2 years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Job:Health Insurance Operations

Organization:Corporate

Location:California-San Rafael

Requisition ID:CEN1048902


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Appeals Navigator

Appeals Navigator Print Apply Appeals Navigator Salary $29.51 - $35.33 Hourly Location Denver, CO Job Type Part Time Department Department of Labor and Employment Job Number KAA-AIV UI-6/17 Closing 6/26/2017 5:00 PM Mountain

  • Description

  • Benefits + Questions Department Information The Colorado Department of Labor and Employment is a values-driven organization, committed to teamwork, collaboration, accountability, adaptability, excellence, integrity and respect. We believe in outstanding customer service, an inclusive culture, continued process improvement, and in our role as a trusted and strategic partner.

    Recognizing that making our employees successful also drives our success, we are eager to invest in dedicated individuals who exhibit our shared values and our passion for quality and excellence in all we do. The work we do is rewarding and, through a variety of divisions and programs. The Colorado Department of Labor and Employment connects job seekers with great jobs, provides an up-to-date and accurate picture of the economy to help decision making, assists workers who have been injured on the job, ensures fair labor practices, helps those who have lost their jobs by providing temporary wage replacement through unemployment benefits, and protects the workplace - and Colorado communities - with a variety of consumer protection and safety programs.

    In addition to rewarding and meaningful work, we offer a variety of benefits that you simply will not find at other employers: + Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401K and 457 plans + Medical and dental health plans + Employer supplemented Health Savings Account + Paid life insurance + Short- and long-term disability coverage + 10 paid holidays per year plus vacation and sick leave + Discounted RTD EcoPass (Denver Metro locations) + BenefitHub state employee discount program + CafeWell employee wellness program + Excellent work-life programs, such as flexible schedules, training and more Our agency website: Colorado Department of Labor and Employment The State of Colorado is an equal opportunity employer. Description of Job This position is open only to Colorado state residents.

    This is a grant funded position. The current grant is from July 1, 2017 until June 30, 2018. The individual hired for this position will be required to sign a waiver of retention rights.

    The position may be extended year to year depending on the availability of funds. This part-time position is eligible for State of Colorado benefits. This purpose of this position is to provide guidance to employers regarding worker classification.

    Worker classification rules determine if an individual is an employee or an independent contractor for purposes of unemployment insurance eligibility. The position will develop guidance for employers on factors that determine worker classification; will clarify the processes that employers or individuals should follow to submit additional information to this department in response to a legal determination and prior to an appeal; position will serve as a resource to the employer community on certain classification and audit matters. This position is a staff authority in worker classification.

    Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights MINIMUM QUALIFICATIONS: Education and Experience: Graduation from an accredited college or university with a bachelor's degree in Criminal Justice, Civil Justice, or Dispute Resolution AND three years of professional experience as a Hearings Officer who presided over appeals hearings for unemployment insurance claims.

    Substitutions: A combination of work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount, and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor's degree. A JD or LLB degree may be substituted for the bachelor's degree and at the agency's discretion, for one or two years of required experience respectively. Required Competencies:

  • Expert in the Unemployment Insurance Appeals process.

  • Expert in worker classification. Preferred Skills/Experience: + Preferred candidate will have at least 5 years of experience holding Unemployment Insurance appeals hearings.

  • Experience explaining processes without providing legal advice.

  • Outstanding customer service skills for in-person and phone customers. Conditions of Employment: + As a condition of employment, you must successfully pass a background check (both criminal and unemployment insurance benefit overpayments). APPEAL RIGHTS:

    If you receive notice that you have been eliminated from consideration for the position, you may protest the action by filing an appeal with the State Personnel Board/State Personnel Director within 10 days from the date you receive notice of the elimination. Also, if you wish to challenge the selection and comparative analysis process, you may file an appeal with the State Personnel Board/State Personnel Director within 10 days from the receipt of notice or knowledge of the action you are challenging. Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director's Administrative Procedures, 4 CCR 801, for more information about the appeals process.

    The State Personnel Board Rules and Personnel Director's Administrative Procedures are available at www.colorado.gov/spb. A standard appeal form is available at: www.colorado.gov/spb. If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within 10 days of your receipt of notice or knowledge of the action:

    Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax: 303-866-5038.

    Phone: 303-866-3300. The ten-day deadline and these appeal procedures also apply to all charges of discrimination. Supplemental Information Minimum Qualification Screening A Human Resources Analyst will only review the work experience/job duties sections of the online job application to determine whether you meet the minimum qualifications for the position for which you are applying.

    Cover letters and resumes WILL NOT be accepted in lieu of the official State of Colorado online application, but may be attached. Part-time work experience will be prorated. Applicants must meet the minimum qualifications to continue in the selection process for this position.

    Work experience and qualifications must be specifically documented on your online application. Do not use "see resume" or "see attached" statements on your application. Resumes WILL NOT be reviewed for minimum qualification screening.

    Comparative Analysis Process – Structured Application Review After minimum qualification screening, the comparative analysis process for this position will involve a review and rating of all the information you submit with your application materials. Therefore, it is extremely important to document in the work experience/job duties portion of your online application the extent to which you possess the education, experience, minimum qualifications, and preferred qualifications as outlined in the job announcement. It is also important to thoroughly answer all supplemental questions as your answers to these questions will be evaluated during this phase.

    Any attachments such as cover letters, resumes or other documents that support your experience may also be reviewed during this phase. Supplemental Questions Answer the supplemental questions on the application completely and thoughtfully. Your answers may be rated based on your writing ability (spelling, grammar, and clarity of your writing) as well as the content of your answer.

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