- Emanate Health (Covina, CA)
- …and all other non-governmental third-party payers. Duties include collections, appeals , billing, adjustments, EOB review, correspondence and managing all types ... setting, with strong emphasis on managed care contract and appeals /underpayment collection activities. Excellent customer service skills. Knowledge of collection… more
- US Physical Therapy (Garden City, NY)
- …Physical Therapy is growing and looking for a **motivated, detail-oriented Accounts Receivable Specialist ** to join our Garden City team! This role is essential in ... claims from submission through payment + Follow up on denials, rejections, and appeals to ensure reimbursement + Communicate with insurance carriers and patients to… more
- Seattle Children's (Seattle, WA)
- …coding and documentation compliance. **Required Credentials** Certified Coding Specialist -Physician Based (CCS-P) certification by the American Health Information ... Experience in revenue cycle functions, including coding denial management and appeals process. Experience in research of payer policy and coding guidelines.… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …systems and communicate relevant information to the originating physician, facility, or specialist + Apply knowledge of product lines and regulatory requirements in ... phone or online before processing authorizations + Assist with complaints and appeals related to eligibility and claims, documenting information accurately in the… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals ; Policies and procedures. + Identify opportunities for training and… more
- BJC HealthCare (St. Louis, MO)
- …work experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both ... Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level of… more
- TEKsystems (Addison, TX)
- …terminology,medical biller,anesthesia Additional Skills & Qualifications - Proven experience as an Appeals Specialist or in a similar role within a healthcare ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... diagnosis and procedure codes to assure properly assigned MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS… more
- Modivcare (Ridgeland, MS)
- …be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is responsible for establishing ... superior customer service and to reduce the number of official complaints through positive and effective working relationships with customers, providers, and agencies. This role will work identify root causes of issues and provide real time solutions for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... 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
- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the ... full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and… more
- Nuvance Health (Danbury, CT)
- …44, MOON, Connecticut notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * ... Assists with informing Managed Care contracting team with necessary contractual language to protect organization financial position specific to inpatient medical necessity requirements. * Employs creative solutions with team members and leadership to prevent… more
- McLaren Health Care (Mount Pleasant, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- Molina Healthcare (Omaha, NE)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals … more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... Collaborate with clinical staff and coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed records in the… more
- Sanford Health (SD)
- …clinical documentation, and interpreting medical policies. The As a lead position, lead appeals and denial specialist this role will additional support the leads ... remote **Job Summary** Responsible for performing advanced level work related to appeals and denials by conducting a comprehensive review of clinical documentation,… more
- LA Care Health Plan (Los Angeles, CA)
- …dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters to ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- The County of Los Angeles (Los Angeles, CA)
- …Accountant I Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services ... Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services Assistant I Financial… more
