- University of Utah (Salt Lake City, UT)
- …**Requisition Number** PRN41434B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals & Coding Specialist III **Job Grade** ... more
- Community Health Systems (Fort Smith, AR)
- **Job Summary** The Appeals Specialist I is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following ... more
- CDPHP (Albany, NY)
- …accreditation and other regulatory requirements. Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review ... more
- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... more
- CareFirst (Baltimore, MD)
- …**PURPOSE:** This Position will support government programs lines of business. The Appeals Specialist II will be responsible for the initial analysis ... 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, ... 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 ... more
- TEKsystems (Sarasota, FL)
- …,Denials, Medical Claims Additional Skills & Qualifications Appeals and denials medical claims medical appeals medical denials insurance claims ... 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, ... more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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 ... 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 ... more
- Healthfirst (AL)
- …+ Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring ... 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 ... more
- Molina Healthcare (Columbus, OH)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously ... more
- Rush University Medical Center (Chicago, IL)
- …and procedures set forth by the Care Management Department and Rush University Medical Center. 9. Coordinates clinical appeals process and participates in in ... more
- Catholic Health Services (Farmingdale, NY)
- …to gather necessary medical documentation and clinical data to support the appeals process. Develop and maintain a system for tracking all appeals , including ... 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 ... more
- Johns Hopkins University (Baltimore, MD)
- …mail, edits reports, file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher level specialist . + Informs the supervisor / ... more
- Johns Hopkins University (Middle River, MD)
- …mail, edits reports, file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher level specialist . + Informs the supervisor / ... more
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