- US Tech Solutions, Inc. (Columbia, SC)
- …and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following ... guidelines. . *40% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.… more
- Beacon Hill (Robinson Township, PA)
- …Identify any payer coverage restrictions- Document prior authorization and appeals protocols- Communicate regularly with internal and external partiesRequirements:- ... 1+ year(s) of experience in a healthcare or call center based role - Previous experience working in benefits verification a plus- Excellent communication skills- Computer proficiencyTo get your foot in the door with this reputable company, apply today!Beacon… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- …provided in the hospital and office setting. Knowledge of the appeals processes for different payers.Knowledge of electronic billing systems and EMR'sAbility ... to work and resolve problems independently and demonstrate task completionDemonstrate thorough knowledge and understanding of CBO Policies and Procedures as well as the NGHS handbookDemonstrate thorough understanding of Medicare and commercial waivers if… more
- Penske Truck Leasing Co., LP (Reading, PA)
- …or manager with operating tax compliance processes including rendition/return filing, appeals and abatements and refund/bill entry. * Be able to understand ... or manager with operating tax compliance processes including rendition/return filing, appeals and abatements, bill entry for operating tax * Analyze processes,… more
- Senior Living Communities (North Branford, CT)
- …Wage/employment verifications * Garnishments * Respond to unemployment claims and prepare for Appeals Hearing as needed * FMLA/LOA paperwork and follow up on due ... Work Environment, and Expected Hours of Work: The physical demands described here are representative of those that must be met by an employee to successfully perform… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …verification result call. Welcome calls. Advanced alternate coverage research. Appeals /Denials. Intakes and reports adverse events as directed. Provides exceptional ... issues. Work Environment: The work environment characteristics described here are representative of those an associate encounter while performing the essential… more
- Elevance Health (Indianapolis, IN)
- **Title: Grievance/ Appeals Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The **Grievance/ Appeals Representative I** is responsible for reviewing, analyzing and processing claims in accordance… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Appeals and Authorization Representative will perform activities to help facilitate ... limited to the following: Review providers' requests for services and coordinate appeals management review. Generate an appeal letter to substantiate the medical… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …Notes indicating that the uploading has been completed and notify the Centralized Appeals Unit's representative assigned to track the appeal that the necessary ... of the reversal is mailed to the appellant, and notify the Centralized Appeals Unit's representative assigned to track the appeal that it has been mailed and… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- NJM Insurance (Hammonton, NJ)
- NJM's General Claims Legal Department is currently seeking to fill a PIP Appeals and Litigation (PAL) Supervisor position in the Hammonton office. The Supervisor ... as new and modified strategies and responsibilities. + Review claims representative 's work product for accuracy, thoroughness, and conformity with NJM's policies… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, September 9, 2024 Centers Plan for Healthy Living's goal is to ... Reviewer will handle expedited and standard requests and ensures that the appeals are processed in accordance with regulations, compliance standards and policy and… more
- HANAC, Inc. (Astoria, NY)
- …integral part of a team with the immigration attorney, Board of Immigration Appeals (BIA) accredited representative , and support staff. The Immigration Paralegal ... will assist the staff attorney and the Program Director in providing legal services, education, and outreach, including coordination of community events, and working under attorney supervision to assist clients on Immigration law matters. The Paralegal will… more
- Catholic Health Services (Melville, NY)
- …Details Under the direction of the Hospital RRC Manager, the RRC Follow-Up Representative is responsible to review all assigned third-party and/ or patient accounts, ... actions as initiating phone calls and website inquiries, drafting and submitting letters/ appeals , attending payer meetings in order to move accounts forward in the… more
- TAD PGS, Inc. (Chicago, IL)
- …employee grievance and disciplinary matters . + Oversees matters related to the Employee Appeals Board and acts as representative of the Employee Appeals ... Board. + Counsels various departments and offices in labor relations and employment matters such as discipline, layoffs, terminations, transfers, and numerous other matters that may arise between management and employees/unions. + Provides advice and counsel… more
- Department of State - Agency Wide (Washington, DC)
- …to Merit Systems Protection Board (MSPB) Acknowledgment Orders; serves as technical representative on MSPB appeals and Foreign Service Grievance Board (FSGB) ... and suitability program to include policy development, discipline, adverse actions, appeals , standards of conduct, performance based actions, mediation of potential… more
- Carle (Urbana, IL)
- Accounts Receivable Representative 2 + Department: Patient Financial Services + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + Employment ... a Friend Save Save Apply Now Position Summary: The Accounts Receivable Representative 2 is proficient in Accounts Receivable Representative 1 responsibilities.… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for ... billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None Join Guidehouse on **Thursday, February 15** for ... you onboard. Join our team as a **Patient Account Representative with expected start dates in February, March, and...Skills . Experience needed for insurance focused opportunities: + Appeals & Denials + Medicare/Medicaid + Commercial & Federal… more
