- Swedish Health Services (Seattle, WA)
- …Re-submit claims to government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as ... **Description** Follow up on insurance denials and aged claims , submit...we must empower them. **Required Qualifications:** + 2 years medical (or healthcare) insurance follow up experience.… more
- Mount Sinai Health System (New York, NY)
- …(Industry-Specific)** : + Healthcare: Experience with utilization management for medical services, procedures, or medications + Insurance : Understanding ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd...management program. This role ensures the appropriate use of medical resources, compliance with regulatory standards, and coordination of… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim… more
- Point32Health (FL)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... service or member services representative in health care or insurance + Preferred: 2 years' Appeals and...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- TEKsystems (Englewood, CO)
- Medical Appeals Specialist (Fully Remote) Make a measurable impact by overturning denials, recovering missed revenue, and improving patient account outcomes. As ... a Medical Appeals Specialist, you'll combine deep payer...claims and payer denial codes, plus hands‑on complex appeals workflows + EMR/EHR experience (ideally Epic and Athena;… more
- Molina Healthcare (WI)
- …licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in coding: DRG, ICD-10, ... to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ... position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations,… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
- Point32Health (MA)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- AmeriHealth Caritas (Philadelphia, PA)
- …letters. **_Investigation and Resolution_** + Collaborate with internal departments such as Claims , Medical Management, Legal, and Compliance to obtain necessary ... . **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the full life… more
- Humana (Lansing, MI)
- …- 3 years of grievance and appeals experience + Previous experience processing medical claims + Bilingual (English and Spanish); with the ability to read, ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...+ Must have experience in the healthcare industry or medical field + Strong data entry skills required +… more
- St. Luke's University Health Network (Allentown, PA)
- …health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): ... root/cause analysis when required. The Analyst will work with HAP's medical directors, nurses, pharmacists, Legal department, and other subject matter experts… more
- Ochsner Health (New Orleans, LA)
- …The Appeals Specialist is responsible for managing and resolving insurance claim denials and underpayments to ensure accurate reimbursement. This role involves ... reviewing medical documentation, interpreting payer policies, and preparing detailed appeal...+ Experience in healthcare or revenue cycle - specifically insurance claim denials. + Strong analytical and organizational skills.… more
- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all diagnosis and procedure codes ... 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… more
- Affordable Care (Monroe, NC)
- …Strong verbal and written communication skills. + Knowledge of dental/ medical insurance processes, including verification, claims , appeals , and denial ... scheduling, patient check-in/out, discussing treatment and financial arrangements, and managing insurance billing to ensure timely, accurate claims and maximum… more
- Affordable Care (New Pt Richey, FL)
- …Strong verbal and written communication skills. + Knowledge of dental/ medical insurance processes, including verification, claims , appeals , and denial ... scheduling, patient check-in/out, discussing treatment and financial arrangements, and managing insurance billing to ensure timely, accurate claims and maximum… more
- CHS (Clearwater, FL)
- **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party ... insurance marketing organizations, and employers. One core service, claims administration, is where submissions for payment/reimbursement/sharing from medical… more
- Humana (Juneau, AK)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... caring community and help us put health first** The Medical Director actively uses their medical background,...of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of… more
- Ventura County (Ventura, CA)
- …a flexible credit allowance of up to $26,626.96 annually to offset the purchase of medical insurance for you and your dependents. + Employee only - $463.99 per ... Veterans Claims Officer I/II/III Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5076468) Apply Veterans...period + Dental and Vision - Dental and Vision insurance is free for all employees enrolled in a… more