- UCLA Health (Los Angeles, CA)
- …to support UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to ... in clinical coding or compliance, strongly preferred + Basic understanding of audit and appeals processes, including methods, tools, and regulatory standards… more
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure verbal ... with CCA departments to help manage and resolve member appeals and grievances. * Act as a liaison between...of the member enrollment database system to ensure successful audit preparation; supports the review data for completeness and… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and… more
- BrightSpring Health Services (Englewood, CO)
- …healthcare professionals. Providing service to all the Amerita locations, the PBM Payer Audit Specialist reviews audit request, compiles and classifies ... and identifies documentation needed to respond effectively and efficiently. The PBM Payer Audit Specialist also performs quality assurance checks for all medical… more
- Baptist Memorial (Memphis, TN)
- Summary The Denial Mitigation Specialist - Denial Escalation Quality Assurance evaluates the adequacy and effectiveness of internal and operational controls designed ... including federal and state regulations and guidelines. The Quality Assurance Specialist will be responsible for analyzing and interpreting trends associated with… more
- State of Colorado (Lakewood, CO)
- …Evaluator and Quality Assurance Specialist --Office of Community Corrections Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4740672) Apply ... Program Evaluator and Quality Assurance Specialist --Office of Community Corrections Salary $70,140.00 - $112,236.00 Annually Location Lakewood, CO Job Type Full Time… more
- Hartford HealthCare (Farmington, CT)
- …departments as needed . Manages relationship with external denials vendor. Reviews audit findings and schedules quarterly meeting to provide updates on denial ... as needed to determine the appropriate course of denial appeals . . Maintains accurate, clear, timely documentation related to.... Assists with processing HIM Coding validation denial and audit finding letters to third party vendor. . Monitors… more
- MyFlorida (Tallahassee, FL)
- 836376 OPS EMPLOYMENT PROGRAM SPECIALIST - 40099808 Date: Oct 2, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Requisition No: 836376 Agency: Commerce Working Title: 836376 OPS EMPLOYMENT PROGRAM SPECIALIST - 40099808 Pay Plan: Temp Position Number: 40099808 Salary: $20.70 /… more
- The New Jewish Home (Bronx, NY)
- …Finance Department in Waters Place, Bronx is seeking a full time Managed Care Billing Specialist to join our team. The Managed Care Specialist is responsible for ... care contracts, create project spreadsheets for submission to payers, write reconsideration appeals and send to MCOs, and be able to communicate both internally… more
- AdventHealth (Altamonte Springs, FL)
- …and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and to all rules and ... further action which includes but is not limited to: charge audit /charge capture denials, charge correction, clinical validation, services deemed experimental,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …denials by: I. Peer-to Peer (P2P) Concurrent appeals ii. Written Concurrent appeals iii. Recovery Audit Contractors & levels of appeal iv. Root cause ... **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the...Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. Provides guidance and interpretation on issues… more
- MyFlorida (Tallahassee, FL)
- 68064245 - FINANCIAL SPECIALIST Date: Nov 18, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Agency: Agency for Health Care Administration Working Title: 68064245 - FINANCIAL SPECIALIST Pay Plan: Career Service Position Number: 68064245 Salary: $1,907.10 -… more
- Internal Revenue Service (Detroit, MI)
- …memoranda, etc. related to Federal taxation. Analyzing and adjudicating tax claims, appeals , settlement offers, or similar work related to Federal tax operations. ... related to Federal taxation. Analyzing and adjudicating tax claims, appeals , settlement offers, or similar work related to Federal...for this position may be conditional upon classification and/or audit of federal tax returns. This audit … more
- Beth Israel Lahey Health (Danvers, MA)
- …interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating ... denials and edits of the same nature. Initiates claim rebilling, written appeals or corrections and obtains and submits information necessary to ensure account… more
- State of Colorado (Denver, CO)
- SOCIAL SERVICES SPECIALIST IV - Denver - Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4736840) Apply SOCIAL SERVICES SPECIALIST ... and being a site leader in federal audits and audit findings for practice in Colorado as they relate...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Lakewood, CO)
- Compliance Specialist I - Interlock Unit Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4727451) Apply Compliance Specialist I - ... and procedures for the ignition interlock program + Visit and learn how to audit all approve interlock provider service centers + Learn how to identify deficiencies… more
- Elevance Health (Plano, TX)
- …+ Auditing the performance of Referral Specialists, assisting in the review of audit appeals and documenting audit statistics. **Minimum Requirements:** ... pharmacies, our infusion centers, and the home setting. **Title** : Referral Specialist III - Paragon Healthcare **Location** : 3033 W President George Bush… more
- Shinda Management Corporation (Queens Village, NY)
- Compliance Specialist About the Organization For over three decades, SMC has been in the forefront of proven, quality real estate property management services in the ... community by redefining affordable housing. Description SMC is seeking a Compliance Specialist to join our compliance department. Under the supervision of the Manger… more
- University of Colorado (Aurora, CO)
- **Annual Giving Production & Data Specialist ** **Description** **University of Colorado Anschutz Medical Campus** **Department: Office of Advancement** **Job Title: ... Annual Giving Production & Data Specialist ** **Position #: 00750092 - Requisition #: 35291** **Job...reports to support identified campus objectives and needs + Audit giving data and prospect data to ensure accuracy,… more