- Daiichi Sankyo, Inc. (Seattle, WA)
- …purpose of this role is to serve as a field-based, product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient ... of care on payer specific nuances related to utilization managements protocols and appeals Partner with DSI oncology field staff to ensure aligned customer approach.… more
- Daiichi Sankyo, Inc. (Boston, MA)
- …purpose of this role is to serve as a field-based product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient access ... of care on payer specific nuances related to utilization managements protocols and appeals Partner with DSI oncology field staff to ensure aligned customer approach.… more
- CNA Insurance (San Francisco, CA)
- …documentation. Prepares or analyzes information on adverse underwriting decisions, rate appeals , underwriting requirements, status and declinations in order to drive ... be hired into one of three Underwriter positions: Underwriter, Underwriting Specialist or Underwriting Consultant. Typically 3-10+ years of related experience. In… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... other internal and external partners to ensure a comprehensive appeals management process. Job Description Specialist II...a comprehensive appeals management process. Job Description Specialist II Key Outcomes: + Serves as daily resource… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise. Represents Carle in clinical meetings and… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Sutter Health (Modesto, CA)
- **Organization:** MMC-Memorial Medical Center **Position Overview:** The Grievances & Appeals Specialist supports the patient and family experience through the ... investigation of patient/family complaints, concerns, and other feedback received by the organizations. Complaints and grievances include, but are not limited to, the care provided by physicians and other health care professionals, potential liability, quality… more
- University of Utah (Salt Lake City, UT)
- …Number** PRN39530B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt ... Coder-Hospital ( CPC -H), Certified Professional Coder-Payer ( CPC -P), Certified Coding Specialist ( CCS ), Certified Coding Specialist - Physician Based (… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- TEKsystems (Addison, TX)
- …to strengthen appeal arguments. Additional Skills & Qualifications: - Proven experience as an Appeals and or denials Specialist or in a similar role within a ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible for providing comprehensive responses in compliance with contract, regulatory and accreditation requirements ... information and communicate disposition of case . + Triages case inquiries, appeals , and prepares case files/packets for appeal hearings. Attend State Fair Hearings… more
- Generac Power Systems (Waukesha, WI)
- …into an energy technology solutions company, we continue to push new boundaries. The ** Appeals and Grievances Specialist ** is a critical team player who is ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution + Handles… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Insight Global (Los Angeles, CA)
- Job Description The Customer Solution Center Appeals and Grievances Specialist I will support the Appeals and Grievances team to receive, investigate and ... resolve member and provider complaints and appeals ; escalate complex issues or questions to leadership team...of this role is to learn the specialty level appeals and grievances work by resolving less complex cases… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered...Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to… more
- TEKsystems (Addison, TX)
- …reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and ... with payer policies, regulations, and industry trends related to claim appeals and arbitration. - Maintain a comprehensive understanding of coding guidelines,… 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 number of ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- Internal Revenue Service (Fresno, CA)
- …CAREERS? Visit us on the web at www.jobs.irs.gov Responsibilities WHAT IS THE APPEALS DIVISION? A description of the business units can be found at: ... Vacancies will be filled in the following specialty areas: Office of Appeals Case and Operations Support Account and Processing Support Special Programs AARS… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... departments in attempts of obtaining authorizations and claim payment. * Establishes and maintains positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines. *… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The Utilization Review Specialist (LVN) is responsible for completion and ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews,...to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests… more
