- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... JOB DUTIES AND RESPONSIBILITIES: Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- University of the Pacific (Stockton, CA)
- Posting Details Position Information Job Title Clinical Services Support/Billing Specialist Union Level Department Audiology Clinic San Francisco Campus San ... Reporting to the Clinic Director and in consultation with the Department Chair, the Clinical Services, the Support Specialist plays a pivotal role in the… more
- Rady Childrens Business Center (San Diego, CA)
- …Client Name Rady Childrens Business Center Job Type Local Offering Non- Clinical Profession Finance/Accounting Specialty Billing Specialist Job ID 16846831 ... Job Title Finance/Accounting - Billing Specialist Weekly Pay $1120.0 Shift Details Shift 8hr Days...and Outlook programs Proficiency in sending paper claims, paper appeals and refund requests Flu vaccine required Client Details… more
- On Point Staffing Group (Little Falls, NJ)
- Join our dynamic team as a Medical Insurance Accounts Receivable Specialist , where your expertise in medical billing will contribute to our financial success. This ... claim rejections and denials to facilitate successful payments. Craft compelling appeals to secure payments on initially denied claims. Preferred Qualifications: A… more
- Movn Health (Los Angeles, CA)
- …Movn Health is seeking a highly experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This ... is a self-starter with a proven track record in A/R recovery, claim appeals , and payer follow-ups. Experience in startup environments and cardiovascular care is… more
- PHI Health (Phoenix, AZ)
- …policies and procedures. Draft correspondence to patients and payers including 1st level appeals for technical denials, and identify accounts to refer to Appeals ... good working knowledge of HCPCS, CPT, ICD-9, ICD10 codes, medical terminology and clinical documentation. Provide leadership and act as a resource for management to… more
- Regal Medical Group, Inc. (West Covina, CA)
- …The QI Nurse will also serve as an intra-team contact for staff for questions on appeals and grievances and offers assistance as may be needed. The QI Nurse is a key ... QI to facilitate the accurate and timely Grievances & Appeals . Acts as the key contact to the QI...QI P & P are followed. QI Team Nurse Specialist is a key member of the QI Department… more
- Experity (Machesney Park, IL)
- …experience: from patients finding clinics and making appointments, to checking in, to clinical documentation, and to the final bill paid by the patient. Our team ... take necessary actions to resolve Submit corrected insurance claims and/or appeals , as necessary, with appropriate documentation based on payer guidelines Prioritize… more
- Vidant Health (Greenville, NC)
- …carriers, CPT code(s), and specialty area, review and submission of coding appeals related to denials to include coding, bundling, duplicate, and other assigned ... researching and reviewing payer coding guidelines, writing and submitting appeals with supporting documentation. Analyzing assigned denials and making necessary… more
- State of Colorado (Canon City, CO)
- …department, to include behavioral health assessments, individual and group therapy, clinical management of offenders with mental illness, and substance abuse issues. ... formal and informal behavioral health evaluations, diagnostic assessments, and clinical interventions. Serves as consultant for unit staff regarding assessment,… more
- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist , is responsible for managing client medical ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Accounting/Finance Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...manner. This position will focus on quality review of non- clinical grievance and appeals cases for all… more
- Robert Half Accountemps (Los Angeles, CA)
- …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , will be in ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your… 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
- Elevance Health (Chicago, IL)
- ** Appeals Referral Specialist ** **Location :** **Hybrid** - This role requires associates to be in-office **3 days per week** , fostering collaboration and ... - Friday 10:30 am - 7:00 pm CST The ** Appeals Referral Specialist ** is responsible for providing...Specialist ** is responsible for providing support to a clinical team in order to facilitate the administrative components… more
- Elevance Health (Irving, TX)
- …our specialty pharmacies, our infusion centers, and the home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - ... weeks/30 days at the Plano, TX office. The **Referral Specialist II** is responsible for providing support to a... II** is responsible for providing support to a clinical team in order to facilitate the administrative components… more
- Molina Healthcare (Midvale, UT)
- …position, home office with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct ... for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that… more
- LA Care Health Plan (Los Angeles, CA)
- …Prepares template determination/education letters for members and providers. Duties Provide non- clinical support to the Customer Solution Center Appeals and ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager, assist with soliciting non- clinical information… more
