- 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 ... the services/treatment rendered. JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for diagnosis and procedure code assignment and… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and ... /grievance filings, and in administrative hearing proceedings. Duties Include: + The Appeals and Grievance Specialist is responsible for managing and resolving… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. ... The Clinical Denials Prevention & Appeals Specialist plays a critical role in...validation issues by leveraging comprehensive knowledge of clinical documentation, medical coding (with special emphasis on ICD-10), payer policies,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial ... a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based...determine if an appeal is warranted. + Formulate clinical appeals and letters of medical necessity to… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... with Medical Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts routine data evaluation for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- McLaren Health Care (Mount Clemens, MI)
- … demonstrating accuracy/proficiency in referencing support from the medical recorddocumentation and coding guidelineswith timely and successful submissions. ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- Molina Healthcare (Everett, WA)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… more
- Actalent (Dallas, TX)
- Job Title: Specialist , Appeals & GrievancesJob Summary: Responsible for reviewing and resolving member and provider complaints and communicating resolutions. Key ... + Use internal systems to determine outcomes of claims appeals and grievances. + Review medical records and billing details to formulate conclusions. + Ensure… more
- Molina Healthcare (IA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Cognizant (Phoenix, AZ)
- …the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Lincoln Financial (Denver, CO)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for ... cycle or business office required + 1-3 years experience in healthcare insurance medical billing preferred **Knowledge, Skills and Abilities** + To perform this job… more
- Nuvance Health (Danbury, CT)
- …with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role ... payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review,...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- TEKsystems (Columbia, SC)
- …ENTRY POSITION, LOOKING FOR COMPUTER AND DATA PROCESSING EXPERIENCE. Performs non- medical reviews and processes redetermination letters. *50% Performs non- medical ... the benefits available for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement… more
- Nuvance Health (Danbury, CT)
- …*Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for...Assists in timely sorting and dissemination of requests for medical information from insurers and other sources to the… more
- Catholic Health (Buffalo, NY)
- …hire, one of the following (or similar) credentials: Certified Documentation Specialist , Certified Coder (CPC/CCS), Certified Processional Medical Auditor ... role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting… more
- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue Cycle Denials Management… more
- Hartford HealthCare (Farmington, CT)
- …other common practices across the system.*__* *_Position Summary:_* The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related ... Key responsibilities include timely investigation of DRG downgrades, submitting appeals , coordinating follow-up actions, and ensuring compliance with regulatory… more