- UnitedHealth Group (Las Vegas, NV)
- …or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, ... inquiry calls/requests with customer service skills as well as research, clinical information system utilizations and resolve formulary and benefit issues using… 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
- Strategic Health Partners (Kennesaw, GA)
- …insurance companies by working with assigned payers. *Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, ... and/or resolving appeals with third-party payers. Research and resolve payer rejected/denied...for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials.… more
- Ultimate (Tarpon Springs, FL)
- …Ultimate Staffing Services is actively seeking a detail-oriented Medical Insurance Collections Specialist to join their client's team in Florida. This role is ... claims, and maintaining compliance with federal and state regulations. The specialist will collaborate with insurance carriers, patients, and internal departments to… more
- Axelon Services Corporation (Hometown, IL)
- Job Description: Disability Claims Specialist MAX PAY RATE - $42 per hour Fully Remote 10-20 hours per week Must have at least 3+ years prior LTD/IDI Insurance ... with both external and internal resources, such as physicians, attorneys, clinical /vocational consultants as needed to gather data such as medical/occupational… more
- Brightstar Care of Ft. Myers/Naples (Naples, FL)
- …We are looking for the an experienced medical Billing and Payroll Specialist . Responsibilities include weekly processing of billing and payroll.. Managing ... Authorizations , appeals and re- submission of claims . Posting cash...Employer matching Insurance: Medical Dental Vision Mileage Reimbursement for clinical / administrative positions Employee Assistance Program Generous Paid… 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
- 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, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… 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 (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
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Dana-Farber Cancer Institute (Brookline, MA)
- The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities ... (CAR) T-cell therapy, and other immune effector cell treatments. The Specialist works autonomously to secure initial and ongoing authorizations, monitor… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4889241) Apply Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction… more
