Top 345 Appeals Jobs in Alabama

Senior Manager, Regulatory Compliance
Behavioral Health Systems, Inc. —Birmingham, AL
- $120,000 - $150,000 a year
- Full-time
- Hybrid work
- 5 years
- Case management
- Travel
- Health insurance
- Dental insurance
Quick Apply
Revenue Cycle Management
CompHealth —Alabama
- Email
- Office
- 3 years
- Supervising experience
- Relocation assistance
Epic Denials Management Operator
Deloitte —Birmingham, AL
- $70,000 - $90,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
12d
Member Appeals & Grievances Specialist I
VIVA HEALTH —Birmingham, AL
- Weekends as needed
- Customer service
- Office
- High school diploma or GED
- Wellness program
- Paid parental leave
Quick Apply
6d
PROGRAM MANAGER
US Defense Intelligence Agency —Redstone Arsenal, AL
- $107,446 - $139,684 a year
- Online Application
- Pass drug screening
- Office
- Analysis skills
7d
Sr. Manager, Pricing - Pharmacy Appeals
CVS Health —Alabama
- $67,900 - $182,549 a year
- Full-time
- Remote
- 7 years
- Microsoft Access
- Office
- Health insurance
- Dental insurance
Field Reimbursement Manager
TSP (A Syneos Health Company) —Birmingham, AL
- $180,000 - $190,000 a year
- Spanish
- HIPAA
- English
- Paid parental leave
- Health savings account
14d
NSO Apprentice Interest
Disabled American Veterans —Montgomery, AL
- $20.18 - $31.39 an hour
- Full-time
- Customer service
- Office
- High school diploma or GED
- On-the-job training
Quick Apply
Accounts Receivable Specialist
Herself Health —Birmingham, AL
- Full-time
- Remote
- Microsoft Word
- Microsoft Outlook
- Computer literacy
Quick Apply
1d
Epic Denials Management Coordinator
Deloitte —Birmingham, AL
- $50,000 - $60,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
12d
Employee Relations Advisor
The Personnel Board of Jefferson County —Birmingham, AL
- $60,486 - $93,828 a year
- Full-time
- Mid-level
- Office
- Training & development
- Paid holidays
- Health insurance
10d
Compliance UM Nurse (Wed - Sun)
Humana —Alabama
- $71,100 - $97,800 a year
- Overtime
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Paid holidays
14d
Insurance Verification Representative - FMG - Women's Healthcare of Dothan
Flowers Medical Group —Dothan, AL
- Full-time
- US work authorization
- Communication skills
- Entry level
- Health insurance
- Dental insurance
Quick Apply
Regional Director of Utilization Management
ADDICTION AND MENTAL HEALTH SERVICES, LLC —Birmingham, AL
- $115,000 - $130,000 a year
- Full-time
- Nursing
- 3 years
- Master's degree
- Loan repayment program
- Health insurance
Quality and Compliance Specialist
PACE —Mobile, AL
- Full-time
- Nursing
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
13d
Service Manager
Confidential —Madison, AL
- $58,000 - $63,000 a year
- Full-time
- Background check
- Mid-level
- Plumbing
- Health savings account
- Health insurance
Quick Apply
13d
Vehicle Installer / Mobile Upfitter
CIBR Warriors LLC —Birmingham, AL
- $19 - $20 an hour
- Full-time
- Background check
- Mid-level
- Power tools
Quick Apply
Maintenance Technician IV - Windsor Place
Foshee Residential Management Company —Mobile, AL
- $23 - $28 an hour
- Full-time
- Background check
- OSHA
- English
- Paid holidays
- Health insurance
Quick Apply
22h
Community Manager
The Scion Group —Tuscaloosa, AL
- Urgently hiring
- Sales
- Inventory management
- Mid-level
- Paid parental leave
- Health insurance
Quick Apply
Home Improvement Sales Consultant
Durante Home Exteriors —Huntsville, AL
- $80,000 - $150,000 a year
- Full-time
- Customer service
- Mid-level
- In-person
- Opportunities for advancement
Quick Apply
1d

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appeals jobs near alabama

Senior Manager, Regulatory Compliance

Behavioral Health Systems, Inc. -
Birmingham, AL

Quick Apply

Job Details

Full-time
$120,000 - $150,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Life insurance

Qualifications

Customer communication
Case management
Staff training
Quality improvement
Organizational skills
Quality audits

Full Job Description

Job Overview
Reporting to the Head of Commercial Operation or designee, this position oversees corporate regulatory compliance, internal compliance with BHS corporate, clinical services and other divisional policies, and quality assurance/quality improvement and accreditation activities.

Duties

Compliance

Ensure compliance with TELUS Health/BHS policies and all applicable federal and state regulations, including but not limited to ERISA, HIPAA, MHPAEA, and ACA.
Stay current and informed on all applicable federal and state regulations and compliance requirements. Serve as liaison with BHS healthcare attorneys on legislative/regulatory matters. Recommend and implement policy changes or additions as appropriate to ensure compliance. Serve as a resource for all divisions, clients and BHS customers as appropriate.
Manage TELUS Health (California) Ltd. Knox-Keene license, including board meetings as requested and audits.
Develop client-specific NQTL analyses and requested, in coordination with other divisions and outside counsel as appropriate. Maintain BHS' Book of Business NQTL report.
Oversee TELUS Health/BHS complaints and appeals processes, to include Federal External Reviews. Review all appeals and patient/provider complaints, direct Appeal Committee meetings and prepare appeal/complaint responses as appropriate.
Conduct staff orientation and training on clinical and other policies pertinent to federal and state regulations and requirements, and quality standards. Provide ongoing guidance to staff regarding compliance and quality assurance matters.
Maintain all state license/certification/registration flings, to include name and trademark registrations.
Assist in the development and updating of clients' SPD's, SBC's and other benefit plan documents, and the analysis of client benefits to ensure all are MHPAEA and ACA compliant. Oversee the accurate input of benefits into the BYS system.
Oversee the corporate accreditation process.

Quality Assurance

Oversee corporate quality assurance activities throughout all levels of the organization. Serve on the Quality Assurance (QA) Committee. Promote adherence to corporate and divisional quality assurance policies. Recommend new policies as appropriate.
Conduct divisional quality audits, including but not limited to regular patient chart audits. Utilize audit findings to improve care management effectiveness, corporate customer/patient satisfaction, and services across all BHS departments.
Oversee the review and resolution of patient satisfaction survey concerns. Assist in maintaining the organization's 96% patient satisfaction rating.
Serve as the corporate liaison for all subpoenas, lawsuits, or complaints filed against the company.

Qualifications

Advanced degree preferred.
5+ years' experience in healthcare compliance (Knox-Keene expertise preferred)
5+ years' quality assurance experience
5+ years' mental health parity experience required
Experience in managed care/PPO environment and case management/utilization review
Proficiency in MS Office suite
Strong communication, organization, and problem-solving skills
Experience in staff supervision/training and group presentations
Ability to travel, with advance notice, up to 20% (4 days per month)

Job Type: Full-time

Pay: $120,000.00 - $150,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Vision insurance

Experience:

Mental Health Parity: 5 years (Required)

Work Location: Hybrid remote in Birmingham, AL 35209

Quick Apply

Refine Your Search

appeals jobs in alabama

Senior Manager, Regulatory Compliance

Revenue Cycle Management

Epic Denials Management Operator

Member Appeals & Grievances Specialist I

PROGRAM MANAGER

Sr. Manager, Pricing - Pharmacy Appeals

Field Reimbursement Manager

NSO Apprentice Interest

Accounts Receivable Specialist

Epic Denials Management Coordinator

Employee Relations Advisor

Compliance UM Nurse (Wed - Sun)

Insurance Verification Representative - FMG - Women's Healthcare of Dothan

Regional Director of Utilization Management

Quality and Compliance Specialist

Service Manager

Vehicle Installer / Mobile Upfitter

Maintenance Technician IV - Windsor Place

Community Manager

Home Improvement Sales Consultant

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