- Humana (Richmond, VA)
- …a team where your expertise truly makes an impact! As a Grievances & Appeals Representative , you'll be a go-to problem solver, turning complex challenges into ... impact** **Required Qualifications** + 1+ years of grievances and/or appeals experience. + Data entry experience. +...experience. + 2 - 4 years of grievance and/or appeals experience. + Previous experience processing medical claims… more
- St. Luke's University Health Network (Allentown, PA)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials and ... + Must have computer skills and dexterity required for data entry and retrieval of patient information. Must be...**Job Duties** + Review and analyze denied or underpaid claims to determine appeal opportunities. + Prepare and submit… more
- TEKsystems (Farmington, CT)
- …submitted claims that remain unprocessed + Prepare and submit reconsiderations and appeals within filing limits + Perform detailed data analysis and research ... Insurance Follow‑Up Representative (Hybrid) Shift: 7:30 am - 4:00 pm...hospital billing operations. This role focuses on resolving medical claims denials, conducting detailed follow-up with insurance payors, and… more
- Banner Health (Phoenix, AZ)
- …settings by including remote and hybrid opportunities. As a **Provider Experience Representative ** for Banner Plans & Networks you will take inbound calls answering ... will call upon your **background in medical billing, medical claims , customer service, and managed care** to answer complex...goal of first call resolution. As a **Provider Experience Representative ** , you will be working in a hybrid/remote… more
- University of Rochester (Rochester, NY)
- …to successful closure and obtain maximum revenue collection. Researches, corrects, resubmits claims , submits appeals and takes timely and routine action to ... by considering factors including, but not limited to, market data , education, experience, qualifications, expertise of the individual, and...resolve unpaid claims . Mentors and trains new or lower level staff.… more
- US Anesthesia Partners (Austin, TX)
- …without a reasonable accommodation) + Contacts insurance companies for status on outstanding claims . + Processes and follows up on appeals to insurance ... Overview The Accounts Receivable Representative III is responsible for collecting outstanding accounts...Provides peer payer and system training support. + Gathers data and reports out in partnership with leadership. +… more
- SSM Health (Madison, WI)
- …and payment rules. Bills claims appropriately. + Follows up on denied claims by performing appeals and denial recovery procedures. Works denied claim lines ... or more of the following: processing insurance payments, following up on denied claims , and resolving credit balances. May work in multiple functional areas. **Job… more
- Owens & Minor (Springfield, IL)
- … representative follows-up with insurance companies to resolve unpaid claims . **ESSENTIAL DUTIES AND RESPONSIBILITIES** + Researches any overdue account balance ... customers on delinquent payments. + Reviews unpaid and underpaid claims . Resubmits or appeals as necessary. +...a strong ability to understand, interpret and develop spreadsheet data . **Other Skills** **PHYSICAL DEMANDS** This is a stationary… more
- Banner Health (WY)
- …activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a ... CORE FUNCTIONS 1. May be assigned to process payments, adjustments, claims , correspondence, refunds, denials, financial/charity applications, and/or payment plans in… more
- Robert Half Accountemps (Palo Alto, CA)
- …underpayments; research contracts, guidelines and resolve payment with payer. Perform appeals with payer. Performs bad debt request transfers as applicable. Performs ... and resolves edits; Reviews and resolves electronic acknowledgement payer rejections/denials; Rebills claims based on requests from Follow Up reps due to denials… more
- Intermountain Health (Salem, OR)
- …service behavior standards + Perform other duties as assigned **Skills** + Insurance Claims + Medical Billing + Explanation of Benefits (EOB) + Translations + ... such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications),… more
- State of Massachusetts (Boston, MA)
- …work, available for work and looking for a job. The Job Service Representative I performs customer service and issue resolution by assisting employers or claimants ... determinations in accordance with MGL Chapter 151A, 430 CMR, the Job Service Representative 's Handbook, and established Revenue Procedures as well as the Code of… more
- City and County of San Francisco (San Francisco, CA)
- …list. According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are ... procedures; + Reviews and interprets computer-produced reports, daily statistical data , and accounts receivable numbers to monitor overall department performance,… more
- State of Colorado (Pueblo, CO)
- …Coloradans. What we do: Retail Operations provides the sale of Lottery products, claims processing, redemption of prizes, and customer service at the Pueblo, Denver, ... Grand Junction, and Ft. Collins Claims Counters, including providing customer service support to retailers,...from many levels within the organization and community. + Data Entry including: entering information into a program or… more
- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. 10% Keeps… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... include but are not limited to researching, correcting, resubmitting claims , submitting appeals and taking timely and...and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative … more
- State of Colorado (Denver, CO)
- …by the Fiscal Agent. + Leverage data from enrollment information and claims data , the position leads the development of strategies for provider capacity ... + Ensures the Office meets state and federal requirements regarding data sharing and interoperability. This includes steering the overall provider… more
- State of Colorado (Denver, CO)
- …dose cassettes). + Issues credits back to clients. + Process Medicare Part D claims . + Completes associated paperwork and computer data entry. Package and Fill ... of inventory for (near) outdated medication for removal and replacement, data entry, ordering and restocking pharmaceuticals and supplies, pre-packaging and labeling… more
- Amentum (Washington, DC)
- …Fund ("VCF") was created to provide compensation for any individual or personal representative of a deceased individual who suffered physical harm or was killed as ... claim review team work, with a particular emphasis on claim and data management, claim assessment, knowledge management and training coordination. Working closely… more
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