- Community Health Systems (Fort Smith, AR)
- As a Remote Medical Denials / Appeals Specialist at Community Health Systems - Shared Services Center, you'll play a vital role in supporting our purpose to ... flexible scheduling, 401k and student loan repayment programs. The Remote Medical Denials / Appeals Specialist position is remote and full time, which… more
- CDPHP (Albany, NY)
- …accreditation and other regulatory requirements. Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review ... values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance… more
- University of Michigan (Ann Arbor, MI)
- …Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals Specialist has a strong knowledge of medical appeal and audit practices for both ... inpatient and outpatient populations. They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will… more
- VNS Health (Manhattan, NY)
- …as necessary, to investigate and facilitate resolution of individual grievances and appeals . Consults with enrollees, providers and the Medical Director, as ... Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in...a minimum of two years in a grievance and appeals or related area such as medical … more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal… 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, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...cases. Consults with health care providers, vendors, legal representatives, medical , and staff administration, and accurately documents all communication… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Molina Healthcare (Columbus, OH)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… 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,...Tracker, Cerner/ClaimIQ/Artiva, or other programs + Submits requests for medical records, ub's, and itemized bills as needed +… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist I is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following ... to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems,...activity in the Appeal Tracker. + Submits requests for medical records, ub's, and itemized bills as needed. +… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...reflect the standard of care, as defined by the medical staff and the organization; utilizes clinical knowledge and… more
- St. Luke's Health System (Twin Falls, ID)
- …work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical denials by conducting ... clinical documentation to determine if an appeal is warranted. + Reviews patient medical records and utilizes clinical and regulatory knowledge and skills as well as… 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...or related field is preferred. + 3-4 Years of medical coding, denial management, and/or reimbursement experience is required.… more
- Healthfirst (NY)
- …+ Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring ... of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of… more
- LA Care Health Plan (Los Angeles, CA)
- …and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on ... Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- Sutter Health (Modesto, CA)
- …glad you are interested in joining Sutter Health! **Organization:** MMC-Memorial Medical Center **Position Overview:** see below **Job Description** : **EDUCATION:** ... patients on behalf of the organization. + Analytical skills, including medical record review/analysis, investigate of quality-of-care complaints and synthesize facts… 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 ... place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time...response from the payer and takes appropriate action, including appeals , based on the type of denial. Documents all… more
- Johns Hopkins University (Middle River, MD)
- …claims submission requirements for all payors in order to expedite payments. The Specialist will research and interpret medical policies regarding denials based ... + Resolves claim edits + Drafts and resolves non-standard appeals . + Researches medical policies to resolve...medical specialty environment. Classified Title: AR Revenue Cycle Specialist II Job Posting Title (Working Title): PB AR… more
- Robert Half Accountemps (Springfield, MA)
- …Follow-Up Specialist or similar role * Strong knowledge of Appeals and Claim Administration processes * Exceptional communication and interpersonal skills * ... offering a short term contract employment opportunity for an Insurance Follow-Up Specialist in Springfield, Massachusetts. As an Insurance Follow-Up Specialist ,… more
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