Appeal Resolution Manager jobs in Allentown, PA

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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Audit & Appeal Coordinator
  • Grand View Health
  • Sellersville, PA FULL_TIME
  • Schedule: Full Time, 8:30am-5pm, Monday-Friday


    Responsibilities

    Under the general direction of the Manager of Health Information Management, the Audit and Appeals Coordinator coordinates recovery audit contracting activities to ensure that deadlines are adhered to. The Audit and Appeal Coordinator is responsible for hospital compliance with all federal, state and regulatory agencies to manage payer audits and appeals. Assumes the role of system administrator for the Audit and Appeals software product.

    These duties will require the understanding of many complex and varying guidelines, systems, regulations and tools. The Audit and Appeals Coordinator will use critical thinking skills to manage an ever-evolving process that includes financial, clinical and legal components. The Audit and Appeals Coordinator will proactively work with GVH staff and physicians to put processes in place and to correct identified deficiencies that are impacted by retrospective denials.

    Qualifications

    EDUCATION AND EXPERIENCE:
    • High school diploma/GED and over 1 to 3 years of healthcare audit and appeals experience required.

    LICENSES AND CERTIFICATIONS:
    • RHIA or RHIT certification upon hire preferred.
    • Licensed Practical Nurse/Registered Nurse in PA – licensed, upon hire, preferred.

    BENEFITS:
    • Medical, free dental, vision insurance for full time and part time
    • 403B
    • Pension plan
    • On-site discounted child care center
    • Tuition reimbursement up to $5250 per year
    • Free life insurance
    • Free parking
    • Paid time off
    • Sick time
    • Flexible spending accounts
    • Employee referral bonus
  • 22 Days Ago

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Audit and Appeal Coordinator
  • Grand View Hospital
  • Sellersville, PA FULL_TIME
  • Responsibilities Under the general direction of the Manager of Health Information Management, the Audit and Appeals Coordinator coordinates Recovery Audit Contracting activities to ensure that deadlin...
  • 1 Month Ago

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Patient Care Advocate
  • Oakland Manager LLC dba Justice Grown
  • Bethlehem, PA FULL_TIME
  • The Patient Care Advocate (PCA) is responsible for creating an exceptional customer experience for our medical dispensary patients. This role ensures all sales are compliant with state regulations, th...
  • 1 Month Ago

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Manager
  • Urban Air Adventure Park
  • Trexlertown, PA FULL_TIME
  • Manager PA-Trexlertown Manager JOB DESCRIPTION Urban Air Adventure Park is gearing up to ACTIVATE AWESOME. We are seeking a highly-motivated candidate to support our vision. In this role, the Manager ...
  • 1 Day Ago

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Manager
  • American Bread Company
  • Quakertown, PA FULL_TIME
  • Want to work in a place where you can learn, laugh, be supported, be yourself and reach your goals? If so, then Panera is for you. We are a top franchise group with great growth potential, looking for...
  • 1 Month Ago

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Manager
  • Popeyes
  • Whitehall, PA FULL_TIME
  • JOB DESCRIPTIONPosition: Manager Reports To: Above Restaurant LeaderJob Purpose: Manager or Multi- Unit Manager is responsible for leading the overall operations of the restaurant, including recruitin...
  • 20 Days Ago

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0 Appeal Resolution Manager jobs found in Allentown, PA area

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People Operations Partner
  • Spray-tek
  • Bethlehem, PA
  • As a time-tested contract spray drying industry leader with a legacy spanning almost five decades, we take pride in our ...
  • 4/18/2024 12:00:00 AM

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Public Safety & Emergency Management (PSEM) Project Manager
  • PSI International
  • Somerset, NJ
  • Requirement Number : RCI-MWBE-85824Y0794 Job Title: Public Safety & Emergency Management (PSEM) Project Manager Location...
  • 4/18/2024 12:00:00 AM

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Patient Engagement Partner - Access Center, Local Remote Position (PA or NJ residents only)
  • St Luke's University Health Network
  • Allentown, PA
  • St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most ...
  • 4/18/2024 12:00:00 AM

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Corporate Director of Revenue Cycle Management
  • Wesley Enhanced Living
  • Warminster, PA
  • Position Summary: The Corporate Director of Revenue Cycle Management position is an exciting opportunity at Wesley Enhan...
  • 4/17/2024 12:00:00 AM

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Quality Engineer
  • EAM-Mosca Corporation
  • Hazleton, PA
  • EAM-Mosca Corp. Job Title: Quality Engineer Job Type: Full Time, Salaried Exempt Reporting Structure: Reports to Sr. Pro...
  • 4/17/2024 12:00:00 AM

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Quality Engineer
  • EAM-Mosca Corp.
  • Hazleton, PA
  • EAM-Mosca Corp. Job Title: Quality Engineer Job Type: Full Time, Salaried Exempt Reporting Structure: Reports to Sr. Pro...
  • 4/16/2024 12:00:00 AM

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Quality Engineer
  • Eam-mosca Corp.
  • Hazleton, PA
  • EAM-Mosca Corp.Job Title: Quality Engineer Job Type: Full Time, Salaried Exempt Reporting Structure: Reports to Sr. Proc...
  • 4/16/2024 12:00:00 AM

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People Operations Partner
  • Spray-Tek
  • Bethlehem, PA
  • As a time-tested contract spray drying industry leader with a legacy spanning almost five decades, we take pride in our ...
  • 4/15/2024 12:00:00 AM

Allentown (Pennsylvania Dutch: Allenschteddel) is a city located in Lehigh County, Pennsylvania, United States. It is Pennsylvania's third most populous city and the 231st largest city in the United States. As of the 2010 census, the city had a total population of 118,032 and is currently the fastest growing city in all of Pennsylvania. It is the largest city in the metropolitan area known as the Lehigh Valley, which had a population of 821,623 residents as of 2010[update]. Allentown constitutes a portion of the New York City Combined Statistical Area and is the county seat of Lehigh County. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Appeal Resolution Manager jobs
$94,304 to $122,560
Allentown, Pennsylvania area prices
were up 1.5% from a year ago

Appeal Resolution Manager in Racine, WI
General provisions on appeals are contained within CPR PD 52A.
December 03, 2019
Appeal Resolution Manager in Lancaster, PA
All appeals must be submitted in writing to the RC within ten academic calendar days after notification of the Dean of Students’ decision to accept or modify the recommendations resulting from the hearing.
February 06, 2020
Appeal Resolution Manager in San Diego, CA
The Coalition recommended that its members consider resolutions to request the Commission on Marine Resources to go forward with scientific and engineering studies regarding the Pearl River water resource project and creation of the Western Sound Special Management District.
January 16, 2020