- Harbor Health Services, Inc. (Mattapan, MA)
- …management including UM/CM, Grievance and Appeals , inpatient and outpatient services, medical policy, and clinical claims review In-depth experience of Mass ... benefits package including Health, Dental, Vision, Life, & Disability insurance , 403b Savings Plan, Generous Paid Time Off plus...or finance department. Works with UM RNs and Senior Medical Director to deny claims when appropriate.… more
- Swedish Health Services (Seattle, WA)
- …Re-submit claims to government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as ... **Description** Follow up on insurance denials and aged claims , submit...we must empower them. **Required Qualifications:** + 2 years medical (or healthcare) insurance follow up experience.… more
- Centene Corporation (Jefferson City, MO)
- …plan leaders and cross functional stakeholders across the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy, case ... and pharmacy consultants for reviewing complex cases and medical necessity appeals . + Participate in provider...would improve utilization and health care quality. + Review claims involving complex, controversial, or unusual or new services… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim… more
- University of Michigan (Ann Arbor, MI)
- …outpatient populations. They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with ... & Appeals (HBAA) Department?** The Audit and Appeals Specialist has a strong knowledge of medical...guidelines. Combine accounts as necessary prior to release of claims . + Monitor Medicaid retrospective eligibility cases, complete required… more
- Mount Sinai Health System (New York, NY)
- …(Industry-Specific)** : + Healthcare: Experience with utilization management for medical services, procedures, or medications + Insurance : Understanding ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd...management program. This role ensures the appropriate use of medical resources, compliance with regulatory standards, and coordination of… more
- Point32Health (FL)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... service or member services representative in health care or insurance + Preferred: 2 years' Appeals and...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ... position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations,… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
- Point32Health (MA)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- Centene Corporation (Indianapolis, IN)
- …J-1, OPT, or CPT.** **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal ... school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims , related managed care experience, or relevant experience. Pay… more
- Centene Corporation (Phoenix, AZ)
- …state of Arizona.** **Position Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- CareFirst (Baltimore, MD)
- …and responds to internal and external stakeholders, without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and ... **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial...in settings such as managed care, health care or insurance payor environment. **Preferred Qualifications:** + College Degree +… more
- TEKsystems (Addison, TX)
- …the appeals and arbitration process for denied or underpaid claims , ensuring timely and accurate submissions. - Prepare compelling appeal letters, supporting ... processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials, appeals , and arbitration processes, including knowledge… more
- Elevance Health (Tampa, FL)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... implications for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to… more
- Nuvance Health (Danbury, CT)
- …verbal and written communication skills * Excellent organizational skills * Prior Insurance claims processing experience helpful * Notary Public preferred but ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and...* 2 years clerical/computer experience required * Knowledge of insurance protocols preferred * Knowledge of medical … more
- St. Luke's University Health Network (Allentown, PA)
- …health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): ... root/cause analysis when required. The Analyst will work with HAP's medical directors, nurses, pharmacists, Legal department, and other subject matter experts… more
- Ochsner Health (New Orleans, LA)
- …The Appeals Specialist is responsible for managing and resolving insurance claim denials and underpayments to ensure accurate reimbursement. This role involves ... reviewing medical documentation, interpreting payer policies, and preparing detailed appeal...+ Experience in healthcare or revenue cycle - specifically insurance claim denials. + Strong analytical and organizational skills.… more
- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all diagnosis and procedure codes ... MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive… more
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