- Daiichi Sankyo, Inc. (Seattle, WA)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... 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… more
- Amaze Health (Denver, CO)
- …is a company dedicated to empowering our patients with all the tools, resources, and medical support they need to take charge of their own healthcare. We don't just ... our online portal). You will work closely with our medical team to ensure our members get the care...as a liaison between the patient, insurance company and/or medical office(s). + Love the challenge of persistently working… more
- CDPHP (Albany, NY)
- …accreditation and other regulatory requirements. Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review ... 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… more
- VNS Health (Manhattan, NY)
- …as necessary, to investigate and facilitate resolution of individual grievances and appeals . Consults with enrollees, providers and the Medical Director, as ... Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in...a minimum of two years in a grievance and appeals or related area such as medical … more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...the direct supervision and management of the A&G Nurse Specialist , RN and/or Medical Director. This position… 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, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… 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, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- Alight (TX)
- …(https://careers.alight.com/us/en) . **THE ROLE** Are you interested in joining a collaborative Appeals team? As an Appeals Specialist , you'll review ... ensuring each case is effectively tracked and managed through the appeals process. + Assess medical , financial, and non- medical information with the support… 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 ... identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims,...payer-specific appeal requirements and guidelines. - Strong understanding of medical coding (CPT, HCPCS, ICD-10) and medical … more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...reflect the standard of care, as defined by the medical staff and the organization; utilizes clinical knowledge and… more
- LA Care Health Plan (Los Angeles, CA)
- …and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on ... Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department:...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- TEKsystems (Glen Burnie, MD)
- …directly inputting codes on complex or high-value accounts). Skills: Ccs, Cpc, Epic, Medical Coding, Coding, Coder, Medical Coder, Emr, Icd-10, Ehr, Medical ... record Top Skills Details: Ccs,Cpc,Epic, Medical Coding,Coding,Coder, Medical Coder Additional Skills & Qualifications: Education * Current coding certification (RHIA, RHIT, CPC, CCS) is required. Experience Level: Expert Level About TEKsystems: We're… more
- HCA Healthcare (Nashville, TN)
- **Description** **Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient and effective ... and delivery of all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group (PSG). The education… more
- MetroHealth (Cleveland, OH)
- **Location:** **METROHEALTH MEDICAL CENTER** **Biweekly Hours:** **80.00** **Shift:** **8a-430p** **The MetroHealth System is redefining health care by going beyond ... medical treatment to improve the foundations of community health...improve documentation accuracy. Reviews DRG downgrades and strategic CDI appeals , and responds to payor audits and inpatient downgrade… more
- Houston Methodist (Houston, TX)
- …items that result in resolution. Engages the coding follow up team for any medical necessity or coding related appeals . + Assures accounts are completed and ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee… more
- Johns Hopkins University (Middle River, MD)
- …claims submission requirements for all payors in order to expedite payments. The Specialist will research and interpret medical policies regarding denials based ... + Resolves claim edits. + Drafts and resolves non-standard appeals . + Researches medical policies to resolve...medical specialty environment. Classified Title: AR Revenue Cycle Specialist II Job Posting Title (Working Title): AR Revenue… more
- Elderwood (Buffalo, NY)
- …tools, training and resources you need to succeed. Join Our Team as a Medical Billing Specialist ! Are you detail-oriented, dedicated, and passionate about making ... a difference? We are seeking a skilled Medical Billing Specialist to join our Elderwood...any denials and assist in follow up of timely appeals process. + Conduct weekly aging reviews to address… more
- Johns Hopkins University (Middle River, MD)
- …edits reports, file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs the supervisor / Production ... similar medical specialty environment. Classified Title: AR Revenue Cycle Specialist Role/Level/Range: ATO 40/E/02/OC Starting Salary Range: $15.70 - $25.25 HRLY… more
