- Daiichi Sankyo, Inc. (Seattle, WA)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... purpose of this role is to serve as a field-based, product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient… more
- Daiichi Sankyo, Inc. (Boston, MA)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... purpose of this role is to serve as a field-based product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient access… more
- University of Utah (Salt Lake City, UT)
- …**Requisition Number** PRN39530B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E ... of U Health - Academics **Department** 00209 - Univ Medical Billing - Oper **Location** Other **City** Other **Type...-H), Certified Professional Coder-Payer ( CPC -P), Certified Coding Specialist ( CCS ), Certified Coding Specialist … more
- TEKsystems (Addison, TX)
- …medical necessity, and reimbursement methodologies to strengthen appeal arguments. Skills: Appeals , Claim, medical collections, Medical insurance, TDI, ... NSA, commercial insurance, out of network Top Skills Details: Appeals ,Claim, medical collections, Medical insurance #PriorityCentral About TEKsystems: We're… 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
- Sutter Health (Modesto, CA)
- **Organization:** MMC-Memorial Medical Center **Position Overview:** The Grievances & Appeals Specialist supports the patient and family experience through ... and Risk Management Services is required on a frequent basis for complex medical legal issues. Assists staff members who request intervention in diffusing difficult… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... provider pre- and post-service appeals , and participating provider pre-service appeals . The Specialists collaborates with Care Managers, Medical Directors… 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical 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) Nurse Specialist Registered Nurse (RN) II provides… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... Carle enterprise. Represents Carle in clinical meetings and writing appeals on outpatient accounts where medical necessity,...and writing appeals on outpatient accounts where medical necessity, level of care or prior authorization is… more
- Insight Global (Los Angeles, CA)
- Job Description The Customer Solution Center Appeals and Grievances Specialist I will support the Appeals and Grievances team to receive, investigate and ... resolve member and provider complaints and appeals ; escalate complex issues or questions to leadership team...(DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MRMIB) and National Committee for Quality… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- TEKsystems (Addison, TX)
- …to strengthen appeal arguments. Additional Skills & Qualifications: - Proven experience as an Appeals and or denials Specialist or in a similar role within a ... identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims,...payer-specific appeal requirements and guidelines. - Strong understanding of medical coding (CPT, HCPCS, ICD-10) and medical … more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible...OF: Choice of 3 excellent next to zero cost Medical Plans including Dental and Vision. 401K - Agency ... information and communicate disposition of case . + Triages case inquiries, appeals , and prepares case files/packets for appeal hearings. Attend State Fair Hearings… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... claim payment. * Establishes and maintains positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with… more
- Molina Healthcare (Georgetown, KY)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously ... + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training,… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures ... (both medical and surgical) to assure properly assigned diagnostic related...codes, DRG and CPT coding. **REQUIRED SKILLS** Certified Coding Specialist **ABOUT US** **Strength Through Diversity** The Mount Sinai… more
- CareOregon (Portland, OR)
- …and provider appeals & reconsiderations, gather data & documentation and prepare appeals for review by CareOregon Pharmacists & Medical Directors. + Complete ... appeals and notify members and providers of outcome. + Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement… more
- Robert Half Accountemps (Van Nuys, CA)
- …and take appropriate action to collect insurance payments. Requirements Medical Billing, Medical Collections, Medical Appeals , Medical Denials, HMO ... San Fernando Valley is looking to add a Hospital Medical Collections Specialist to the team. The...care * Provide training for Collector I positions * Appeals and denials management. * Engage in Appeals… more
- State of Indiana (Indianapolis, IN)
- Program Specialist Date Posted: Sep 6, 2024 Requisition ID: 449180 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career with the State of ... issue working across business units; Collaborates extensively with Contact Center, Adjudication, Appeals , Special Claims, TFA, Cashiering and BPC staff on a variety… more
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