- UCLA Health (Los Angeles, CA)
- …to support UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to ... in clinical coding or compliance, strongly preferred + Basic understanding of audit and appeals processes, including methods, tools, and regulatory standards… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Officer** **Job Class: Revenue Tax Specialist Senior or Revenue Tax Specialist Principal** **Agency: Revenue Department** + **Job ... **Travel Required** : No + **Salary Range: Revenue Tax Specialist Senior:** $31.92 - $47.05 / hourly; $66,648 -...variety of multi-issue individual, partnership, S-corporation, estate, and fiduciary appeals arising from the audit process of… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist II is responsible for follow-up of all appeals submitted. This individual manages denial/appeal correspondence and ... imperative for the department to run efficiently. As an Appeals Specialist II at Community Health Systems,...Manages workflow for all incoming appeal determination letters & audit correspondence via centralized email and isynergy folders +… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...reviews with MDs, and preparation of case samples for audit review. This position works collaboratively with the AG… more
- Molina Healthcare (Columbus, OH)
- …following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance… more
- Genesis Healthcare (Seven Fields, PA)
- …with our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up of denied ... response from the payer and takes appropriate action, including appeals , based on the type of denial. Documents all...type of denial. Documents all necessary elements; reason for denial/ audit , denial status, and action taken in the electronic… more
- Hartford HealthCare (Farmington, CT)
- …tracking and follow-up of requests for information, and timely coordination of appeals and associated deadlines. The Audit Coordinator will also work ... other common practices across the system. *_Position Summary:_* The Audit Coordinator works under the direct supervision of the...in collaboration with the Denials Specialist I. *_Position Responsibilities:_* *Key Areas of Responsibility* 1.… more
- Independent Health (Buffalo, NY)
- …correlating coding complexity. They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise and ... knowledge and audit tips across the team. The Clinical & Coding Specialist -Senior will support the leadership in Hospital Audit in accomplishing all aspects… more
- Baptist Memorial (Memphis, TN)
- Summary The Denial Mitigation Specialist - Denial Escalation Quality Assurance evaluates the adequacy and effectiveness of internal and operational controls designed ... including federal and state regulations and guidelines. The Quality Assurance Specialist will be responsible for analyzing and interpreting trends associated with… more
- State of Colorado (Denver, CO)
- Internal Audit Section Manager Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4786190) Apply Internal Audit Section Manager Salary ... for overtime compensation. Department Contact Information Sarah Roman, Talent Acquisition Specialist ~ ###@state.co.us How To Apply Please submit an online… more
- State of Colorado (CO)
- Intake and Resource Specialist - Social Services Specialist IV - Remote Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4829268) Apply ... Intake and Resource Specialist - Social Services Specialist IV -...and monitoring of the 24-hour childcare facilities and to audit and investigate reports/allegations involving licensing violations, facility or… more
- Hartford HealthCare (Farmington, CT)
- …and other common practices across the system. *_JOB SUMMARY_* The Denials Specialist 1 is responsible for HIM Coding denial resolution and prevention activities ... as needed to determine the appropriate course of denial appeals . * Collaborates with clinical staff and/or outside providers...* Assists with processing HIM Coding validation denial and audit finding letters to third party vendor (HROI). *… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** The Denial Specialist will identify, review, and interpret third-party payments, adjustments, and denials. ... Initiates corrected claims, appeals , and analyzes unresolved third-party and self-pay accounts, initiating...meetings and serves on committees as requested. Maintains appropriate audit results or achieves exemplary audit results.… more
- Medical Mutual of Ohio (OH)
- …their best possible health and quality of life. **Medicare Sales Operations Specialist ** Executes all end-to-end functions relating to the investigation of sales ... and complaints to the Medicare Advantage Sales Compliance area issued via Appeals and Grievances (A/G), the Complaint Tracking Module (CTM) and other internal… more
- Hackensack Meridian Health (Hackensack, NJ)
- …denials by: I. Peer-to Peer (P2P) Concurrent appeals ii. Written Concurrent appeals iii. Recovery Audit Contractors & levels of appeal iv. Root cause ... **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the...Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. Provides guidance and interpretation on issues… more
- AdventHealth (Altamonte Springs, FL)
- …and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and to all rules and ... further action which includes but is not limited to: charge audit /charge capture denials, charge correction, clinical validation, services deemed experimental,… more
- State of Colorado (Colorado Springs, CO)
- Youth Services Specialist I (YSSI) - Education Support Specialist - Spring Creek Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4820674) ... Apply Youth Services Specialist I (YSSI) - Education Support Specialist ...to prevailing legal standards, CDHS Policy, DYS Policy, DYS Audit Standards and Implementing Procedures. Adheres to CDHS and… more
- Guthrie (Sayre, PA)
- Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as a group leader by participating in staffing and employment issues. ... Serves as a resource specialist within the department. Trains Insurance Billing Specialists I...to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing procedures to… more
- State of Colorado (Denver, CO)
- SNAP QA Compliance Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4820591) Apply SNAP QA Compliance Specialist Salary ... state, and county agencies of the results of the audit . Apprises federal, state and county agencies of the...of the department's action. For more information about the appeals process, the official appeal form, and how to… more