- Optum (San Juan, PR)
- …in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. This position will communicate with appropriate parties ... regarding appeals and grievance issues, implications and decisions. In addition,...when appropriate Review member benefit information, provider specific information/contracts, claims , applicable SOPs, nuance grid, delegation status, state specific… more
- Guidehouse (San Antonio, TX)
- Job Family: Patient Account Representative Travel Required: None Clearance Required: None What You Will Do: The Insurance Patient Account Representative is an ... offices and three days from home. Essential Job Functions Account Review Appeals & Denials Medicare/Medicaid Insurance Follow-up Customer Service Billing UB-04 & CMS… more
- Mitchell Martin (Linden, NJ)
- …and edits from payors or clearinghouses. * Monitor and follow up on unpaid claims using aging reports; handle appeals and documentation requests. * Manage ... One of our client is seeking for a Orthopedic Medical Billing Representative (Ancillary Services) Type : Perm Schedule: Mon-Fri, 8am-4:30pm Location : Linden, NJ… more
- NYULMC (Boynton Beach, FL)
- …(AR) - Central Billing Office Onsite - Boynton Beach, FL. The Billing Representative III submits claims , follows-up on unpaid balances (insurance or patient), ... submits authorization/precertification requests with insurance companies, follows up on denied claims and/or authorizations, and submits appeals as necessary.… more
- Rezolut (Syracuse, NY)
- …collections, including telephone calls, accessing payer websites, checking claim status, process appeals on denied and underpaid claims , etc. Identify issues and ... applications to determine the next appropriate work activity Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or… more
- Optum (San Juan, PR)
- …Government entities by identifying waste and error in provider billing practices. The Appeals Representative is responsible for determining the accuracy of the ... accuracy. They must demonstrate an ability to maneuver through all applicable claims applications (COSMOS, UNET, Facets, Pulse, etc.), and over 19 internal… more
- ChristianaCare (Wilmington, DE)
- …accounts receivable including, but not limited to, reporting, analysis, disputes, appeals , and reconciliation of acute hospital/facility claims . PRINCIPAL DUTIES ... trend analysis to management, leadership, and insurance liaisons. Writes and submits appeals when claims deny incorrectly. Works rejection and late charge… more
- Chisago County (Center City, MN)
- …for conciliation and County Court and testifies in court as appropriate. Attends appeals and other hearings on claims , probates, health insurance benefits, ... Date: July 28, 2025 $35.91 to $47.29 DOQ Title: Fiscal Operations Representative Updated: 12/5/2022 Department: Health and Human Services Reports to: Fiscal… more
- Medical AR Management Services, LLC (Houston, TX)
- …A/R they are assigned to for all carriers in regard to aging, collection rates, appeals , rejections and claims with no activity. This position will also post ... as needed and responsible for the follow up on all outstanding insurance claims . The collections specialist will work the aging reports as directed by the… more
- Strategic Health Partners (Kennesaw, GA)
- The Accounts Receivable representative is responsible for ensuring all eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer ... are documented appropriately in the patient accounting system. Additionally, the AR representative will be responsible for the tracking and trending of recovery… more
- Acuity Eye Group (Arcadia, CA)
- … claims with appropriate insurance payor Submits reconsiderations, redeterminations and appeals when applicable Resubmits corrected claims to various optical ... to perform prompt submission and follow up of optical claims in addition to timely ordering of materials (eyeglasses...with or without accommodation. The requirements listed below are representative , but not all inclusive, of the knowledge, skill,… more
- Zenith (Sarasota, FL)
- …reviews if a contested case goes to trial. Partners with effective interaction with claims and claims legal. May involve assisting with special projects. The ... compliance. Monitors billing for trends. Communicates with providers regarding disputed claims and payments. Ensures an ongoing working relationship with providers.… more
- Ultimate (Sacramento, CA)
- …Staffing Services is actively seeking a dedicated and compassionate Member Service Representative (Healthcare) to join our client's team in Natomas. The MSR serves ... for new MSRs. Assist members, providers, brokers, and plan partners with claims -related billing questions and issues as needed. Collaborate with inter and… more
- Selective Insurance Company of America (Wayne, PA)
- …office. Provides legal representation to insureds of the Company in defense of litigated claims . Provides advice to the claims department of the Company and ... before the assigned Court and presents witnesses and evidence on litigated claims . Analyzes complex legal and factual issues, conducts extensive, well-reasoned legal… more
- Howard County, MD (Ellicott City, MD)
- …position handles complex quasi-judicial administrative cases before the Board of Appeals and the Zoning Board-including reviewing case records, advising Board ... development plan approvals, notice of violation situations, and administrative appeals heard by the Board of Appeals ...AND WORK ENVIRONMENT: The physical demands described here are representative of those that must be met by an… more
- Covenant Health (Lubbock, TX)
- **Description** ** Claims Appeals Representative ** **Works collaboratively with Case Management (CM) Leadership, Case Managers (CM), Complex Discharge ... 3 or more years of experience in managed care claims / reimbursement setting or experience working in another other...1 or more years of experience in managed care claims / reimbursement + 1 or more years of… more
- State of Nevada (NV)
- UNEMPLOYMENT INSURANCE REPRESENTATIVE 5 - Underfill for ESD Appeals Referee 1 APPROXIMATE ANNUAL SALARY - $61,721.28 to $91,496.16 PAY GRADE: 34 The salary range ... to accomplish goals and objectives. This recruitment is for an Unemployment Insurance Representative 5, underfill for ESD Appeals referee 1. The incumbent will… more
- Point32Health (Watertown, MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
