- Martin's Point Health Care (Portland, ME)
- …Place to Work" since 2015. Position Summary Job Description Position Summary: The Appeals Specialist (Medicare or US Family Health Plan) is responsible for ... standards in accordance with CMS requirements + Cross-trains with US Family Health Plan Appeals Specialist to perform functions as needed US Family Health Plan… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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
- Universal Health Services (Richmond, VA)
- …Rico and the United Kingdom. The Atlantic Region CBO is seeking a dynamic and talented Appeals Specialist . The Appeals Specialist is responsible for the ... relating to technical issues identified during the billing of claims and the follow-up on the clinical appeals... claims and the follow-up on the clinical appeals performed by the facilities. Key Responsibilities include: +… more
- Trinity Health (Farmington Hills, MI)
- …as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves ... payment delays and/or variances resulting from rejected and/or denied claims and/or overpayments and underpayments with direction from the Supervisor Payment… more
- Molina Healthcare (NM)
- …agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
- MCG Health System (Augusta, GA)
- … for the denied claims are submitted appropriately. The Denial and Appeals Specialist will use payor guidelines, carrier websites, coding edits tools such ... Denials and Appeals Specialist Work Location: Satellite Location...responsible for timely and accurate resolution of denied insurance claims . This position reviews all pertinent information to ensure… more
- Trinity Health (Farmington Hills, MI)
- …Maintains knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues ... resolves payment delays and/or variances resulting from rejected and/or denied claims and/or overpayments and underpayments. Processes payments as appropriate in… more
- Alight (TX)
- …of Be Alight. Learn more at careers.alight.com. **About the Role** The Appeals Specialist reviews adverse determination outcomes for Short Term Disability ... **Do you want to be part of a collaborative Appeals team?** **Our Story** At Alight, we believe a...and Long-Term Disability claims . They ensure compliance with regulatory requirements and make… more
- Generac Power Systems (Waukesha, WI)
- ** Appeals & Grievances Specialist I** **Company** Generac Power Systems **Name** Appeals & Grievances Specialist I **Req #** 64199 **Employment Type** ... and enjoy a fast-paced, high-performance culture. **Job Summary:** The Appeals and Grievances Specialist is a critical...equivalent + 1 year experience in escalations, resolutions or claims **Nice to Haves:** + Previous experience using SAP… more
- Universal Health Services (Bonham, TX)
- …day. TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare ... payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II...and recommends updates on policy and procedure critical to claims process. Perform other duties as assigned. Duties Continued… more
- Randstad US (Dallas, TX)
- medical appeals and denials specialist . + dallas , texas + posted april 30, 2024 **job details** summary + $20 - $20.93 per hour + temp to perm + high school + ... further. Must have at least 2 years of backend appeals and denials experience. salary: $20 - $20.93 per...Billing + ICD-10 + Medical Billing - Denials + Claims Processing + HIPAA Qualifications + Years of experience:… more
- University of Virginia (Charlottesville, VA)
- …and obtain payment by coordinating resolution to rejected, denied, and outstanding claims to ensure timely collections. + Analyzes accounts that are not resolved ... within the time specified by the contract using their knowledge of coding and utilizing various tools of CPT and ICD-10 to determine causes of unresolved issues. Selects the most efficient and effective follow up strategy to resolve the accounts to obtain… more
- MetLife (Oriskany, NY)
- Long Term Disability Claims Specialist II Location(s) + Posting Location:Tampa, Florida + Posting Location:Oriskany, New York Country United States Working ... Posted Date 10-May-2024 Job ID 2617 **Description and Requirements** **Long Term Disability Claims Specialist II** **Job Title: Long Term Disability Claims … more
- City of Columbus (Columbus, OH)
- Workers' Compensation Claims Specialist (Employee Benefits Analyst II) (Vacancy) Print (https://www.governmentjobs.com/careers/columbusoh/jobs/newprint/4505699) ... Apply Workers' Compensation Claims Specialist (Employee Benefits Analyst II) (Vacancy)... claims ; reviews, certifies, and rejects requests and claims ; files waivers and/or appeals when necessary;… more
- Billings Clinic (Billings, MT)
- …Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Claims Specialist I (Full-time/Billings) PATIENT ... 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 (Santa Ana, 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
- TEKsystems (Waco, TX)
- … specialists to support a growing healthcare company in the Waco area! As a claims follow up specialist on our team you will be verifying insurance information, ... you have experience working within medical insurance roles handling claims , payer portals, appeals , AR follow up,...increase cash flow Day to Day Duties: - Each specialist will be assigned an inventory to work. New… more
- Office of Personnel Management (Washington, DC)
- Summary As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be part of Healthcare and Insurance, Office of Personnel Management. ... from Postal enrollees and/or their authorized representatives, including responses on appeals of disputed health benefit claims , benefits regulations, and… more
- TEKsystems (Wausau, WI)
- Description: A Medical Billing & Claims Specialist is responsible for working and managing Accounts Receivable for our Clinic and Surgery Center and providing ... our Clinic and Surgery Center. Follow up on unpaid claims . Process credit balances within a timely manner. Research...a timely manner. Research account denials and file written appeals when necessary. Check each insurance payment for accuracy… more