- 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
- University of Utah (Salt Lake City, UT)
- …Number** PRN40045B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA ... Coder-Hospital ( CPC -H), Certified Professional Coder-Payer ( CPC -P), Certified Coding Specialist ( CCS ), Certified Coding Specialist - Physician Based (… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical, operations, pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a number of ways… more
- Johns Hopkins University (Middle River, MD)
- … and rejections processes to resolve standard issues or escalate to a more senior specialist . **Specific Duties & Responsibilities** + Uses A/R follow-up systems ... file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs the supervisor / Production Unit Manager of… more
- Prime Therapeutics (Columbus, OH)
- …Title** Sr Resolution Specialist **Job Description** The Resolution Specialist Sr is responsible for owning the Pharmacy contract termination processes. ... appropriate tracking information regarding potential pharmacy terminations and termination appeals ; receive and prepare audit documentation supporting pharmacy termination… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 09/05/2024 **Requisition Number** PRN39766B **Job Title** Billing Specialist , Sr **Working Title** Billing Specialist , Sr **Job ... and to resolve claim issues. 4. Coordinates and resolves denials including the appeals process. 5. Processes changes in systems to support accurate and efficient… more
- Rochester Institute of Technology (Rochester, NY)
- …Department of Biomedical Engineering at RIT is seeking applicants for Senior Staff Specialist - Grad Studies. The Sr . Staff Specialist for Graduate ... **9279BR** **Position Title:** Sr Staff Specialist - Graduate Studies...or graduate program director with student waiver of suspension appeals + Prepare student full time equivalency forms to… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 10/25/2024 **Requisition Number** PRN40195B **Job Title** PS Sr Laboratory Specialist **Working Title** PS Sr Laboratory Specialist ... medicinal chemistry and vascular surgery. We seek a lab specialist to manage lab logistics, perform seminal scientific experiments,...assist in managing laboratory setup, and inventory. If this appeals to you, please apply by sending your CV… more
- CACI International (Washington, DC)
- Sr Congressional and Public Affairs Specialist /Advisor Job Category: Consulting Time Type: Full time Minimum Clearance Required to Start: TS/SCI Employee Type: ... PREM). More About the Role: As a Congressional and Public Affairs Specialist /Advisor you will: + Collect, review, assess, and demonstrate congressional information,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *SUMMARY:* We are currently seeking a*Prior Authorization Representative Senior *to join our*Financial Securing*team. This full-time role will primarily work remotely ... (SHIFT: Days M-F). *Purpose of this position:*The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Coding Specialist position is responsible for applying correct coding conventions to patient charge encounters in a clinical ... errors in the electronic health record. In addition, the Sr Coding Specialist position is responsible for...posting to the assigned work queues. + Investigates and appeals unpaid, denied and partially paid claims by third… more
- Clark County, NV (Las Vegas, NV)
- SENIOR AIR QUALITY SPECIALIST Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4689835) Apply SENIOR AIR QUALITY SPECIALIST ... Sustainability is seeking qualified candidates to apply for the Senior Air Quality Specialist position in their...printed materials and a computer screen; and hearing and speech to communicate in person or over the telephone.… more
- Clark County, NV (Las Vegas, NV)
- SENIOR ECONOMIC DEVELOPMENT SPECIALIST Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4705378) Apply SENIOR ECONOMIC DEVELOPMENT ... Development is seeking qualified candidates to apply for the Senior Economic Development Specialist position. This individual...printed materials and a computer screen; and hearing and speech to communicate in person or over the telephone.… more
- Sacramento County (Sacramento, CA)
- Senior Behavioral Health Peer Specialist Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2979607) Apply Senior Behavioral Health ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...best describes how you meet the minimum qualification for Senior Behavioral Health Peer Specialist . Current or… more
- MetLife (Bloomfield, CT)
- …a meaningful impact in the lives of our customers and our communities. The Senior Long Term Disability (LTD) Claims Specialist evaluates long term disability ... within prescribed time service standards. In this role, the Senior LTD Claims Specialist is required to...thorough manner. Identifies and refers appropriate matters to our appeals , complaint or litigation support areas * Compiles file… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- The Senior Coding Specialist is responsible for performing coding tasks required to promote efficient operation of the physician practices within Chesapeake ... + Report all payments on collection claims to the Collections Specialist (s) + Attend required hospital-wide orientations, meetings, and in-services + Demonstrate… more
- Insight Global (Naperville, IL)
- Job Description The Senior HR Compliance Specialist is responsible for supporting the HR Operations Excellence team with all compliance related processes such as ... for suitability to hire. Provide timely follow-ups and follow-throughs on all appeals stemming from pre-adverse or adverse results. File appropriate reports with… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Senior Contract Specialist works closely with Corporate Governance (Legal), Government Affairs, Product, Marketing, ... Insurance Administration surveys as needed and assigned. Responds to Central Appeals Unit, Executive Inquiry, Corporate + Audit and other department inquiries… more
- Amazon (Arlington, VA)
- …sellers around the world. Amazon is seeking an experienced Health & Welfare Operations Senior Specialist to join our Benefits Operations Services Team. This role ... savings related topics. Work with internal employee support teams to manage appeals and exceptions intake, review and determination. (5% of role) Basic… more
- CVS Health (St. Paul, MN)
- …Responsibilities** - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more