- Genmab (Berkeley Heights, NJ)
- …has experience in case management, phone-based support work and the health insurance landscape. Patient Service Specialists are critical in the success and quality ... and the healthcare provider (including their office staff) to navigate through insurance coverage and access of the medicationNavigate patients and offices through… more
- BJC HealthCare (St. Louis, MO)
- … appeals team! In this role, you will be analyzing trends for insurance appeals and denials as well as participating in provider huddles. **Overview** ... Qualifications** **Role Purpose** The Patient Accounts Analyst ensures that all insurance , accounts receivable and billing processes are completed accurately and… more
- Healthfirst (FL)
- …+ Minimum of two (2) years of work experience in Managed Care Health Insurance Plan + Experience with appeals for Medicare, Medicaid, Dual enrollment and ... certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + Research… more
- Iowa Department of Administrative Services (State Of Iowa, IA)
- …will be placed on the eligible list. The Iowa Department of Inspections, Appeals , and Licensing, Unemployment Insurance Appeals Bureau, seeks ... a positive and professional attitude The Iowa Department of Inspections, Appeals , and Licensing, Unemployment Insurance Appeals Bureau, as a State of Iowa… more
- Mount Sinai Health System (New York, NY)
- …in the department as per protocol + Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements first step of ... information in Allscripts + Meets time frame for reviews / appeals as specified by Insurance / State & Federal regulation. + Enters concurrent review information… more
- Whidbey General Hospital (Coupeville, WA)
- …refunds, and audits. + Inputs statistically numbers in online reports. + Prepares insurance appeals and follows up as required. + Processes technical denials. ... responsible for coordinating patient referrals and subsequent follow up, verifying insurance and providing financial counseling to assist with self-pay accounts, as… more
- University of Virginia (Charlottesville, VA)
- …has assigned AR responsibility. + Performs inpatient/outpatient follow up and working insurance denials, appeals claims as defined by payer and departmental ... The Central Billing Office (CBO) Insurance Resolution Specialist handles and resolves all Insurance billing follow up and denial issues to ensure all facilities… more
- Robert Half Finance & Accounting (Colorado Springs, CO)
- …identify payment discrepancies and patterns like downcoding or out-of-network adjustments by insurance companies. + Appeals and Denials: Manage insurance ... + Communication Tracking: Document all communications with patients and insurance companies, ensuring HIPAA compliance. + Reporting and Analysis: Generate… more
- CommonSpirit Health at Home (Loveland, OH)
- …certifications. Proficiency in billing and collections processes, with a focus on insurance appeals and account resolution.. At CommonSpirit Health at Home, ... Level II is a mid-level role responsible for resolving insurance and self-pay accounts, including managing claim appeals... insurance and self-pay accounts, including managing claim appeals . This role requires a high level of attention… more
- Beth Israel Lahey Health (Cambridge, MA)
- …writing skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer ... of care. Applies knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of care and risk management issues.… more
- Guthrie (Sayre, PA)
- …within the unit. Takes the necessary action to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing ... Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as...skills and proficiency in analyzing complex billing problems, prepares appeals , challenges payer policies and pursues appeal turnover when… more
- Spectrum Billing Solutions (Skokie, IL)
- …This is a remote or home/office hybrid position. Responsibilities: + Research and resolve insurance denials + File appeals on denied or underpaid claims + Check ... We are looking to add a passionate and skilled Insurance AR Collections Specialist to our growing team. The...skills and knowledge to ensure optimal reimbursement by performing insurance collections. This role includes all aspects of revenue… more
- Insight Global (Nottingham, MD)
- …system in the Maryland/DC area. This person will be overseeing and managing the insurance denial and appeals process to minimize financial risk and improve ... to medical necessity and assess the feasibility of submitting appeals . * Draft medical summaries of denied cases for...for escalation to legal or regulatory bodies (eg, Maryland Insurance Administration) when necessary. * Identify root causes and… more
- Avera (Le Mars, IA)
- … filing and billing policies/procedures are kept current. + Facilitate the processing of insurance appeals of problem claims. + Prepare daily and monthly bills ... at Floyd Valley Healthcare in our Business Office / Insurance Department!** Floyd Valley Healthcare in Le Mars, IA...(40 hours per week) in our Business Office / Insurance Department for a Patient Accounts Coordinator. Floyd Valley… more
- Tufts Medicine (Stoneham, MA)
- …and resolution of accounts including providing documentation records to assist with insurance appeals if a denial is received. 15. Maintains collaborative, ... all-inclusive list. Other duties and responsibilities may be assigned. 1. Contacts insurance companies, and workers compensation carriers to obtain verification of … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This role ... quality monitoring and training. This role partners directly with Appeals leadership to support on-going team development and growth....Experience + 3+ years of experience in the health insurance field. + Proven experience and success in a… more
- AmeriHealth Caritas (Newark, DE)
- …about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances, this position is responsible for the ... administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals ,...Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day… more
- Catholic Health Services (Melville, NY)
- …advisors and facility departments. Develops/validates daily work lists for Utilization and Appeals Manager. Assist with all insurance and regulatory audits and ... Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial management. ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on clinical documentation… more
