- 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 ... Medicare Managed Care Manuals + For USFHP Focused Specialist : + Researches, processes and resolves all appeals... Specialist : + Researches, processes and resolves all appeals in accordance with Tricare and NCQA guidelines. +… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals correspondence, and determination of ... organizing and tracking information to facilitate and expedite processing of appeals received from a variety of sources. Responsible for more complicated,… 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
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop internal compliance controls,… more
- Community Health Systems (Sarasota, FL)
- **Job Summary** The Appeals Specialist I is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following ... service units to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems, you'll play a vital role in… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... 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
- Community Health Systems (Fort Smith, AR)
- As a Remote Medical Denials / Appeals Specialist at Community Health Systems - Shared Services Center, you'll play a vital role in supporting our purpose to help ... scheduling, 401k and student loan repayment programs. The Remote Medical Denials / Appeals Specialist position is remote and full time, which is 40 hours per… more
- St. Luke's Health System (Twin Falls, ID)
- …great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical denials by ... maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to departmental operating… 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 ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… 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)
- …technology solutions company, we continue to push new boundaries. **Job Summary:** 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
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory… more
- VNS Health (Manhattan, NY)
- …to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the appeals ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Training & Performance Location: Los ... achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II...Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training… more
- Community Health Systems (Franklin, TN)
- …Other duties may be assigned. + File medical necessity and level of care appeals using InterQual and CMS guidelines as needed. + Monitor clinical appeal processes ... persons. + Maintain documentation regarding all payor resources regarding denials and appeals processes. + Understand and apply CHS 10-Step Appeal Process for denied… more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... as needed. + Prior experience in Case Management, Utilization Review, and Appeals /Denials, highly preferred. *Additional Salary Detail The salary range and/or hourly… more
- TEKsystems (Annapolis, MD)
- …Schedule : Monday - Friday (Normal Business Hours) Position Summary: As a Coding Appeals Specialist , you will be a crucial member of the denial management ... Hybrid Coding Appeals Analyst Opportunity to join one of Maryland's most renowned and established healthcare systems. This organization is committed to excellence in… more
- Molina Healthcare (Columbus, OH)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… 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: Administrative, HR, Business...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
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