- R1 RCM (Jenkintown, PA)
- …answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims . Appeals Specialist incumbents must be assessed as being ... went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... as well as other internal and external partners to ensure a comprehensive appeals management process. Job Description Specialist II Key Outcomes: + Serves… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (ALD) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise. Represents Carle in clinical meetings and… more
- Generac Power Systems (Waukesha, WI)
- …into an energy technology solutions company, we continue to push new boundaries. The ** Appeals and Grievances Specialist ** is a critical team player who is ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution + Handles… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures ... of ICD-9 codes, DRG and CPT coding. **REQUIRED SKILLS** Certified Coding Specialist **ABOUT US** **Strength Through Diversity** The Mount Sinai Health System… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Claims Specialist I - CBO ... claims from government and third-party payers. The Claims Specialist is responsible for preparing and...of refunds, if appropriate, and coordinating adjustments, when necessary, claims appeals or resubmissions, moving balances from… more
- Illumination Foundation (Riverside, CA)
- …across Orange County, Los Angeles County and the Inland Empire. Job Description The Claims Specialist is responsible for accuracy of claims submission, ... benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts… more
- Whitney Young Health Center (Watervliet, NY)
- Claims Coding Specialist (Req 100825) Watervliet, NY... in accordance with contracts, calling payers on open claims , sending appeals on denied claims ... (http://maps.google.com/maps?q=1601+Broadway+Watervliet+NY+USA+12189) Apply Description GENERAL RESPONSIBILITIES: Responsible for reviewing medical claims prior to submission and following up on more… more
- MetLife (Bloomfield, CT)
- …lives of our customers and our communities. The Senior Long Term Disability (LTD) Claims Specialist evaluates long term disability insurance claims in ... time service standards. In this role, the Senior LTD Claims Specialist is required to exercise independent...thorough manner. Identifies and refers appropriate matters to our appeals , complaint or litigation support areas * Compiles file… more
- MetLife (Cary, NC)
- …* Independently manage an assigned caseload of the most complex claims which consists of pending, ongoing/active and appeal reviews. Provides timely, ... balanced and accurate claims reviews, documentation and recommended decisions in a time...thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. * Serves as… more
- Robert Half Accountemps (Fort Wayne, IN)
- …are offering a contract to permanent employment opportunity for an Insurance Follow-Up Specialist in FORT WAYNE, Indiana. This role is in the healthcare industry and ... will involve follow-ups on medical claims . The workplace environment is business casual and requires...Manage Insurance Denials and Payer Denials, and handle Medical Appeals . * Leverage expertise in Insurance Follow-up, Claim Denials,… more
- AIG (Lenexa, KS)
- …to make more of your specialist expertise and experience. Make your mark in Claims Our Claims teams are the proven problem solvers of choice for clients, ... and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported… more
- Robert Half Accountemps (West Palm Beach, FL)
- Description We are looking for a proficient Medical Billing/ Claims /Collections specialist to join our dynamic team in the healthcare industry. This role will be ... accounts and taking decisive actions when necessary * Administering claims and appeals in line with healthcare regulations * Conducting billing functions… more
- Johns Hopkins University (Middle River, MD)
- …Specialist_** who will be responsible for the basic collection of unpaid third-party claims and standard appeals , using various JHM applications and JHU/ PBS ... etc) as needed and submits to third-party payers. + Appeals rejected claims and claims ...or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs… more
- CareOregon (Portland, OR)
- …Pharmacy Technician Certification. Core responsibilities include customer service, claims processing, prior authorizations, formulary exceptions, appeals , ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Benefit Specialist II Exemption Status Non-Exempt Department Pharmacy Manager Title Pharmacy… more
- Federal Highway Administration (Lakewood, CO)
- …and is a technical expert on construction means and methods in the defense of claims and trial appeals . The ideal candidate should be a technical expert in ... aspects of highway design and construction, and experience resolving contractor claims and requests for equitable adjustments. Responsibilities As a Civil Engineer… more
- State of Colorado (CO)
- …liaison for intake and assessment of employee leave and benefits-related issues, including claims , disputes, and appeals ; + Assist in conducting objective and ... thorough internal reviews of benefits concerns, leave claims , or appeals related to FMLA, Workers' Compensation, Short-Term Disability, and other employee… more
- Randstad US (Franklin, TN)
- …by managing various aspects of the revenue cycle process. This includes handling appeals and denials management to ensure that claims are processed efficiently ... revenue cycle specialist . + franklin , tennessee + posted 6...Denials Management: Review, analyze, and resolve denied or rejected claims . Prepare and submit appeals with supporting… more