- Guardian Life (Bethlehem, PA)
- Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The ** Appeals Case Manager II** (ACM 2) is responsible ... for adjudicating assigned appeals for Group Life and Disability claims. The ACM...million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to… more
- Robert Half Accountemps (Melbourne, FL)
- …As a Medical Biller/Collections Specialist, your primary focus will be on collecting insurance data, processing insurance appeals , and maintaining accurate ... to permanent employment opportunity. Responsibilities: * Accurately and efficiently collect insurance data from patients and physician practices to facilitate … more
- Texas Health Resources (Dallas, TX)
- …+ ** Insurance Referral experience (strongly preferred)** + **Completing Insurance Appeals experience (strongly preferred)** + **Surgery scheduling for ... appointments and medical care, obtain referrals prior to procedures, and complete insurance appeals when required + Ensures all required tests needed prior to… more
- Guthrie (Sayre, PA)
- …within the unit. Takes the necessary action to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing ... Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as...skills and proficiency in analyzing complex billing problems, prepares appeals , challenges payer policies and pursues appeal turnover when… more
- Spectrum Billing Solutions (Skokie, IL)
- …receivable collections. This is a remote/hybrid position. Responsibilities: + Research and resolve insurance denials + File appeals on denied or underpaid claims ... use their skills and knowledge to ensure optimal reimbursement by performing insurance collections. This role includes all aspects of revenue cycle collections… more
- Whidbey General Hospital (Coupeville, WA)
- …refunds, and audits. + Inputs statistically numbers in online reports. + Prepares insurance appeals and follows up as required. + Processes technical denials. ... responsible for coordinating patient referrals and subsequent follow up, verifying insurance and providing financial counseling to assist with self-pay accounts, as… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- University of Michigan (Ann Arbor, MI)
- …for both the inpatient and outpatient populations. They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will ... Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join...Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals … more
- Point32Health (TX)
- …(https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Elevance Health (Columbus, OH)
- **Manager II Grievance/ Appeals (RN)-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... locations. **Expected Work Hours:** Monday-Friday; 8am-5pm PST The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating ... requires strong clinical and medical coding skills to review provider claim appeals for medical necessity, appropriate coding, and pricing of claims for payment.… more
- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert on ... clinical appeals and denials management. Every day you will support...compliance with payer policies and regulations, and negotiate with insurance companies to resolve disputed claims. + Collaborate with… 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, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Elevance Health (Harrisburg, PA)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** _Elevance ... for Medicare and Medicaid Services to transform federal health programs. The **SCA Appeals Representative I** position is an entry-level position in the NGS … more
- Medical Mutual of Ohio (Brooklyn, OH)
- … Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service, billing or related operations preferred. **Professional ... and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures....contribution. + Excellent medical, dental, vision, life and disability insurance - insurance is what we do… more
- Iowa Department of Administrative Services (Des Moines, IA)
- Assistant Attorney General - Criminal Appeals Appellate Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4787704) Assistant Attorney General - ... Criminal Appeals Appellate Salary $61,110.40 - $150,404.80 Annually Location Des...year. + Great Benefits: Excellent Health, Dental, and Vision Insurance Options. + Retirement Plan: IPERS Retirement package and… more
- Centene Corporation (Oklahoma City, OK)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. ... and report verbal and written member and provider complaints, grievances and appeals + Prepare response letters for member and provider complaints, grievances and… more
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- CVS Health (Hartford, CT)
- …in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C appeals (both provider and ... for the enterprise. * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management staff. * Participate… more