- Humana (Lansing, MI)
- …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
- Point32Health (FL)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Point32Health (MA)
- …. **Job Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… 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
- 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 ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… 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 and ... **Job Duties** + Review and analyze denied or underpaid claims to determine appeal opportunities. + Prepare and submit...staff and coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed… more
- Texas Veterans Commission (Borger, TX)
- …rulings, and state law in the adjudication process. . Prepares and files claims and appeals with supporting evidence for successful adjudication. . Advises ... Financial Operations* **Organization:** **TEXAS VETERANS COMMISSION* **Title:** *TVC - Claims Benefit Advisor (Veterans Services Representative I)* **Location:**… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Patient Account ... Representative (PAR)** is expected to perform specific billing processes,...taking necessary actions to obtain account resolution + Submits appeals , as appropriate, for all non-clinical denials + Monitors… more
- Guidehouse (El Segundo, CA)
- …Required** **:** None **What You Will Do** **:** The **Insurance Patient Account Representative ** **(Hospital Claims )** is an extension of a client's business ... and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up + Customer Service + Billing… more
- Mendocino County Sheriff's Office (Ukiah, CA)
- …Must obtain accreditation by the California Department of Veterans Affairs as a Claims Representative in accordance with Title 38 Code of Federal Regulations ... such as military, medical, and legal records. + Prepares, submits, and monitors claims and appeals through appropriate federal, state, and local channels,… more
- Insight Global (Nottingham, MD)
- …diploma or equivalent * Outpatient hospital billing experience * Experience with facility claims follow-up & appeals handling o Experience with UB04 forms o ... is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the...corrective actions with payers. This team focuses on facility claims only, and this role is focused only on… more
- UNC Health Care (Chapel Hill, NC)
- …philosophy. Job Responsibilities: + Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals , response to denials, and ... a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials. + Works… more
- Guidehouse (San Marcos, CA)
- …San Marcos office and three days from home._** **Essential Job Functions** + Hospital Claims + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...+ 1+ year's medical provider experience working with UB04, appeals & denials. + Hospital or EOB claims… more
- Banner Health (Tucson, AZ)
- …settings by including remote and hybrid opportunities. As a **Provider Experience Representative ** for Banner Plans & Networks you will take inbound calls answering ... will call upon your **background in medical billing, medical claims , customer service, and managed care** to answer complex...goal of first call resolution. As a **Provider Experience Representative ** , you will be working in a hybrid/remote… more
- New York State Civil Service (Albany, NY)
- …Yes Agency Attorney General, Office of the Title Senior Consumer Frauds Representative or Consumer Frauds Representative Trainee (NY HELPS) Occupational Category ... of health care complaints, including, but not limited to billing and claims reimbursement disputes; denials of coverage for medical treatment, prescriptions, and… more
- BJC HealthCare (St. Louis, MO)
- … to assist with physican billing follow up. Duties for this role include working claims , contacting payors, and filing appeals in hopes to get payment on ... schools in the country. **Preferred Qualifications** **Role Purpose** The Patient Accounts Representative II serves as a subject matter expert in ensuring the timely… more
- Guidehouse (Birmingham, AL)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The Central Denials ... Account Representative conducts thorough account reviews to determine the appropriate...resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/Manager as needed with various projects.… more
- Elevance Health (Columbus, GA)
- …provider satisfaction. + Researches and resolves the complex provider issues and appeals for prompt resolution. + Coordinates prompt claims resolution through ... **Network Management Representative ** **Location:** _Hybrid1:_ This role requires associates be...is granted as required by law. The **Network Management Representative ** provides comprehensive services to the provider community through… more
- Owens & Minor (Springfield, IL)
- … representative follows-up with insurance companies to resolve unpaid claims . **ESSENTIAL DUTIES AND RESPONSIBILITIES** + Researches any overdue account balance ... insurance carriers or customers on delinquent payments. + Reviews unpaid and underpaid claims . Resubmits or appeals as necessary. + Verifies payment information… more
- SSM Health (MO)
- …and payment rules. Bills claims appropriately. + Follows up on denied claims by performing appeals and denial recovery procedures. Works denied claim lines ... the following: processing insurance payments, following up on denied claims , and resolving credit balances. Typically works in no...and no response claims to resolve outstanding accounts. + Analyzes credit balances… more