- Molina Healthcare (Columbus, OH)
- …agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and ... and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set...Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health … 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...wellness programs + Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care + Generous tuition reimbursement for… 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 ... Description Contribute to the success of a world-class healthcare organization by ensuring compliance in regulatory audits...systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop… 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...and recommends updates on policy and procedure critical to claims process. Perform other duties as assigned. Duties Continued… 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
- 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...to join one of Maryland's most renowned and established healthcare systems. This organization is committed to excellence in… more
- Guidehouse (San Antonio, TX)
- …/ business setting. **What Would Be Nice To Have** **:** + Has active understanding of healthcare claims appeal process + UB-04 / CMS 1500 background + PC skills ... at ###_** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up +...+ High School Diploma/GED or 3 years of relevant healthcare and/or business experience in lieu of High School… more
- Whitney Young Health Center (Albany, NY)
- Claims Coding Specialist (Req 100825) Albany, NY... in accordance with contracts, calling payers on open claims , sending appeals on denied claims ... date . Four (4) years of progressive experience in medical billing and claims processing in a multi-specialty healthcare setting. Professional coding experience… more
- Robert Half Accountemps (Bedford Park, IL)
- Description We are looking for a meticulous Medical Insurance Claims Specialist to join our team based in Bedford Park, Illinois. As a Medical Insurance ... Claims Specialist , you will play...* Proven experience in Accounts Receivable (AR) within a healthcare setting * Familiarity with the Appeals process,… more
- Robert Half Accountemps (Villa Park, IL)
- …documenting all communication in our database. * Use your knowledge of healthcare billing claims processing and insurance procedures to identify decision ... makers at healthcare providers offices and initiate refund requests from claim...knowledge in Accounts Receivable (AR) * Experience in handling Appeals is required * Should be adept at managing… more
- TEKsystems (White Marsh, MD)
- AR Specialist ( Healthcare ) Monday-Thursday 8am-4:30pm Friday 7am-3:30pm Description: The AR Specialist will evaluate financial responsibility of patients, ... billing, EPIC, GE, commercial payors, Payment posting, collections accounts receivable, appeals , denied claims Additional Skills & Qualifications Must have… more
- Robert Half Accountemps (Flint, MI)
- …claim administration * Familiarity with CMS Platform operations * Experience in handling appeals related to medical claims * Proficient in managing billing ... Description We are a healthcare organization based in Flint, Michigan, United States,...in Flint, Michigan, United States, currently seeking a Medical Claims Analyst. In this role, you will be responsible… more
- Priority Health Care (Marrero, LA)
- JOB SUMMARY: The Revenue Cycle Specialist II must adhere to the Code of Ethical Conduct and foster positive relationships within the company, across departments, and ... include following up on claim status, billing and re-billing of claims , credit balance resolution, denial management, following up on aging accounts,… more
- Prime Healthcare (Aurora, IL)
- …generation process breakdowns. This position will collaborate with key stakeholders to develop appeals or redeterminations for any claims that require a review ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/186610/pharmacy-business-and-revenue-cycle- specialist -%28il%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Hartford HealthCare (Farmington, CT)
- …collection of third party revenue cycle activities associated with outstanding insurance claims across all Hartford HealthCare hospitals, medical group and ... this is *your moment.* **Job:** **Finance / Patient Accounts* **Organization:** **Hartford HealthCare Corp.* **Title:** *Collections Specialist / PA Third Party… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …errors and resubmit claims + Report all payments on collection claims to the Collections Specialist (s) + Attend required hospital-wide orientations, ... The Senior Coding Specialist is responsible for performing coding tasks required to promote efficient operation of the physician practices within Chesapeake Regional… more
- Maxim Healthcare Services (Columbia, MD)
- Maxim Healthcare Services is hiring for a Reimbursement Specialist who will serve as liaisons between office partners, patients and payers. Daily ... follows up on unpaid accounts after expected payment timeframe + Corrects, resubmits claims and/or appeals claim determinations as necessary to ensure payment +… more
- CEENTA (Huntersville, NC)
- Primary Objective The Insurance Specialist creates and sends medical claims for the insurance companies and the patients. The Insurance Specialist is ... correct amount. Other responsibilities include following up on unpaid claims , clarifying discrepancies, reviewing bills, and confirming eligibility. Essential… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... management and appeals process in a collaborative environment with revenue cycle...FUNCTIONS** + Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes… more
- Elevance Health (Grand Prairie, TX)
- …normal channels. + Works with internal business partners (sales, member experience, claims , medical review, appeals , etc.) and external contacts within the ... **Title: Plan to Plan Service Specialist I** **Location:** This position will work a...of contact in responding to all Plan to Plan claims inquiries and resolving related issues. Plan to Plan… more
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