- 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
- CDPHP (Albany, NY)
- …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 ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… 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 ... claims, ensuring each case is effectively tracked and managed through the appeals process. + Assess medical, financial, and non-medical information with the support… 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
- 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
- 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
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… 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 ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… 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
- 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 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...Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall… 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered...Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to… more
- TEKsystems (Glen Burnie, MD)
- …1. Performs retrospective and prospective account reviews and resolves coding edits to ensure that coding is accurate and documentation supports reimbursement. 3. ... Analyzes coding-related denials (for problems such as bundling issues and inappropriate 4. CPT/diagnoses) to identify trends and root causes. 5. Develops process improvements for coding and documentation workflows based on denial analysis and industry coding… more
- TEKsystems (Odenton, MD)
- …+ Performs retrospective and prospective account reviews and resolves coding edits to ensure that coding is accurate and documentation supports reimbursement. + ... Analyzes coding-related denials (for problems such as bundling issues and inappropriate. + CPT/diagnoses) to identify trends and root causes. + Develops process improvements for coding and documentation workflows based on denial analysis and industry coding… more
- Amaze Health (Denver, CO)
- …Amaze Health 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 take care of people, we partner with them. Join our innovative team as we change healthcare in America, one patient at a time. We are looking for an independent, personable, fast learner to help us provide the best possible experience for every one… 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
- 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 ... for the basic collection of unpaid third-party claims and standard appeals , using various JHM applications and JHU/ PBS billing applications. Communicates… 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
- Robert Half Accountemps (Los Angeles, CA)
- …service. We are now seeking a experience in Hospital Government Medical Collections Specialist with Appeals experience to join our dedicated team of ... medical care to our community. As a part of our team, the Hospital Government Medical Collections Specialist will be crucial in maintaining our high standard of… more
Related Job Searches:
Appeals,
Appeals Grievances Specialist,
Appeals Specialist RN,
Clinical Appeals Specialist,
Clinical Appeals Specialist RN,
Denials Appeals Specialist,
Grievance Appeals Specialist,
Healthcare Claims Appeals Specialist,
Medical Appeals Specialist,
Specialist