- 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
- CAPPS (Midland, TX)
- …rulings, and state law in the adjudication process. *Prepares and files claims and appeals with supporting evidence for successful adjudication. *Advises ... assisting veterans and eligible persons with the Department of Veterans Affairs claims process. Work involves collaboration with external partners to include the… more
- US Tech Solutions (Myrtle Beach, SC)
- …equivalent. Required Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work ... Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims … more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …values. Logs all calls in Salesforce (CRM platform). Provides status on claims , prior authorizations, and eligibility to Members and Providers. Facilitate phone ... PCP lookup, appointment setting, scheduling transportation, and documenting Grievance and/or appeals ). Follow up on resolution of inquiries and communicating to all… more
- University Medical Center of Southern Nevada (Las Vegas, NV)
- …ability to do discrepancy work-ups. *Proficient analytical skills to resolve complex claims . *Able to read explanation of benefits proficiently. *Must have good ... in scanning and understand the process of follow-up, and denials and appeals Knowledge, Skills, Abilities, and Physical Requirements Knowledge of: Office theories… more
- The Christ Hospital (Cincinnati, OH)
- …including but not limited to: Responsible for the research and resolution of all unpaid claims and the preparation of appeals for rejected or denied claims . ... operating departmental procedures, to pursue prompt payment of professional claims for assigned financial classes, while meeting benchmarks, performance measurements… more
- Heluna Health (Los Angeles, CA)
- …and signed forms needed for disability, age-based, and retirement applications and appeals for SSI, SSDI, and CAPI. Safely and securely manage sensitive personal ... applications that result in benefits awards. Act as the Authorized Representative for clients applying for SSA benefits. Processes benefit survivors' applications… more
- Surgery Partners (Addison, TX)
- …conducted in a timely manner in accordance with payer timely filing limits Correct claims and file appeals with supporting documents to insurance companies, by ... preferred ESSENTIAL FUNCTIONS: Perform extensive insurance claim follow-ups for insurance denials, appeals , and perform next steps a must Ability to utilize multiple… more
- City of Philadelphia (Philadelphia, PA)
- …Rights Unit, Tort Litigation Unit, Code Enforcement Unit, Labor & Employment Unit and Appeals Unit. The Civil Rights Unit represents the City of Philadelphia and its ... its progeny, and the immunities and exceptions provided under the Pennsylvania Tort Claims Act. This position involves providing mentorship and guidance to a team of… more
- UHS (San Antonio, TX)
- …Kingdom. www.uhs.com https://laurelridgetc.com Position Summary: The Patient Account Representative interacts and coordinates with medical insurance providers to ... process claims in a timely and accurate manner. This position...well as underpayments from third party payers and processes appeals and/or claim(s) reconsiderations to insurance companies in a… more
- HCA Healthcare (Pasadena, TX)
- …Do you want to join an organization that invests in you as a Medical Insurance Claims Appeals Representative ? At Parallon, you come first. HCA Healthcare has ... the opportunity to make a difference. We are looking for a dedicated Medical Insurance Claims Appeals Representative like you to be a part of our team. **Job… 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
- 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 ... AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and defend… more
- Penske (Reading, PA)
- …audits, including negotiating with auditors and interfacing with taxing jurisdictions. -Perfect appeals and refund claims . -The position will require the ability ... are required. **Physical Requirements:** -The physical and mental demands described here are representative of those that must be met by an associate to successfully… more
- Texas Veterans Commission (Midland, TX)
- …rulings, and state law in the adjudication process. . Prepares and files claims and appeals with supporting evidence for successful adjudication. . Advises ... Financial Operations* **Organization:** **TEXAS VETERANS COMMISSION* **Title:** *TVC - Claims Benefit Advisor (Veterans Services Representative I)* **Location:**… more
- Guidehouse (Lewisville, TX)
- …San Antonio office and three days from home._** **Essential Job Functions** + Hospital Claims + Account Review + Appeals & Denials + Medicare/Medicaid + ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...+ 1+ year's medical provider experience working with UB04, appeals & denials. + Hospital or EOB claims… more
