- 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
- McLaren Health Care (Port Huron, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met...support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process… more
- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... other levels of the Appeals process. + Assist with internal and external audit processes. + Work with assigned clients to assess trends around payer responses. +… 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 ... Monday-Thursday and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for… 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
- 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 (Grand Junction, CO)
- Youth Services Specialist I (YSSI) - Education Support Specialist - Grand Junction Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4865225) ... 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
- State of Colorado (Brighton, CO)
- …Worker / Counselor I (Behavioral Health Specialist ) - Prairie Vista Youth Services Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4849640) ... Apply Social Worker / Counselor I (Behavioral Health Specialist ) - Prairie Vista Youth Services Salary $2,562.92 Biweekly Location Brighton, CO Job Type Full Time… more
- Dignity Health (Bakersfield, CA)
- …is remote** **within California** **.** **Position Summary:** As a Delegation Management Specialist II, you will play a critical role in managing and monitoring ... requested information to the health plans prior to the audit . May include and/or portions of the following functions:...the health plan. - Partners as needed with the appeals and grievances functions of the department. **Qualifications** **Minimum… more
- State of Colorado (Denver, CO)
- Ongoing Permanency Child Welfare Casework Specialist IV - Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4847032) Apply Ongoing ... Permanency Child Welfare Casework Specialist IV - Hybrid Salary $70,140.00 - $91,188.00 Annually...and being a site leader in federal audits and audit findings for practice in Colorado as they relate… more
- Banner Health (AZ)
- …your abilities - apply today. The Registered Nurse RN Denial Management Specialist is responsible for reviewing concurrent inpatient denials from the insurance ... position is responsible for providing support to the organization's Recovery Audit Contractor (RAC) program by reviewing clinical information and auditing billings… more
- Macphail Center for Music (Minneapolis, MN)
- TITLE: Development Database Specialist REPORTS TO: Vice President for Development COMPANY: Nonprofit, MacPhail Center for Music LOCATION: Minneapolis, hybrid ... $29.36 - $37.70 per hour SUMMARY The Development Database Specialist position is responsible for all gift data entry,...NXT to support digital and web fundraising campaigns and appeals . + Provide updated mailing lists for direct mail… more
- Owens & Minor (Tallahassee, FL)
- …documentation. + Work with billing and collection teams to assure timely submission of all appeals . + Track and report audit findings and results + Ability to ... and assure received documentation meets insurance payer guidelines. When applicable, the audit coordinator will be responsible for accurate and timely response to… more