- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, including any escalated step of… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals /grievance correspondence, and ... organizing and tracking information to facilitate and expedite processing of appeals /grievances received from a variety of sources. Responsible for more complicated,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related… more
- HCA Healthcare (Nashville, TN)
- …of each individual is recognized. Submit your application for the opportunity below: Appeals Specialist . **Benefits** Parallon, offers a total rewards package ... **_Note: Eligibility for benefits may vary by location._** We are seeking an Appeals Specialist for our team to ensure that we continue to provide all patients… 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 ... complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your extensive… 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
- 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 ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- St. Luke's Health System (Twin Falls, ID)
- …place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist , is responsible for managing client medical denials by ... maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to departmental operating… 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 ... diagnosis and procedure codes to assure properly assigned MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS… more
- Lincoln Financial (Lincoln, NE)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… 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 Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Molina Healthcare (Omaha, NE)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers… more
- Molina Healthcare (Caldwell, ID)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination… more
- Texas A&M University System (College Station, TX)
- …organization for resolution. This position manages and investigates employee complaints and appeals . The specialist will develop, implement, and oversee current ... Job Title Employee Relations Specialist Agency Texas A&M Engineering Extension Service Department...Station, Texas Job Type Staff Job Description Employee Relations Specialist $6,065.93 per month 1 Position College Station, Texas… more
- Kilgore College (Kilgore, TX)
- …This position serves as the initial contact for student aid recipients concerning the entire financial aid process; is responsible for daily professional interaction ... with students/parents, faculty/staff, other school officials; scans & links documents in the document imaging system for electronic processing; serves as first line of communications between staff, students, and the community at the Kilgore College - Longview… more
- TEKsystems (Reston, VA)
- Description PURPOSE: The Appeals Specialist II will be responsible for the initial intake analysis of appeals /grievances correspondence and determination of ... collecting organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of sources. Responsible for… more
- R1 RCM (Salt Lake City, UT)
- …questions and obtain appropriate information in pursuit of resolving unpaid claims. Appeals Specialist incumbents must be assessed as being resourceful and ... 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
- The County of Los Angeles (Los Angeles, CA)
- …Accountant I Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services ... Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services Assistant I Financial… more
- State of Arkansas (AR)
- …for manager, legal and appeals tribunal for hearings. Attend hearings and appeals related to each tax specialist 's 515 account. Research and remove any ... appeals tribunal for hearings. + Attend hearings and appeals related to each tax specialist 's 515 account. + Research and remove duplicate wages that were… more
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