- Genmab (Berkeley Heights, NJ)
- …feel like a fit? Then we would love to have you join us!Patient Access Specialist , Call Center Operations The Patient Access Specialist will be the dedicated ... as it pertains to access and reimbursement of prescribed medications. The Patient Access Specialist will be the voice of Genmab to our customers and will maintain… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial ... by conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on clinical… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… 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
- Cognizant (Augusta, ME)
- ** Appeals & Grievance Specialist (remote)** This is a remote position open to any qualified applicant in the United States. **Job Summary:** We are seeking a ... dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel and… more
- Molina Healthcare (Austin, TX)
- …for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… 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
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... goals through quality monitoring and training. This role partners directly with Appeals leadership to support on-going team development and growth. This role creates… more
- Healthfirst (FL)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + ... Work within a framework that measures productivity and quality for each Specialist against expectations + Work independently exercising judgment starting the case… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and… more
- Molina Healthcare (San Antonio, TX)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- LA Care Health Plan (Los Angeles, CA)
- …dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters to ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… 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
- Johns Hopkins University (Middle River, MD)
- …edits reports, file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs the supervisor / Production ... for the basic collection of unpaid third-party claims and standard appeals , using various JHM applications and JHU/ PBS billing applications. Communicates… more
- Johns Hopkins University (Middle River, MD)
- …edits reports, file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs the supervisor / Production ... for the basic collection of unpaid third-party claims and standard appeals , using various JHM applications and JHU/ PBS billing applications. Communicates… more
- Hunterdon Health Care System (Flemington, NJ)
- …variances and takes action to resolve accounts including drafting and submitting technical appeals . In addition, the AR specialist is the subject matter expert ... Position Summary + The Accounts Receivable Specialist role and responsibilities include: monitoring all aspects of the collection of outstanding debts owed to the… 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 ... Financial Specialist I Human Resources Trainee Intermediate Board Specialist Management Assistant Operation Assistant Personnel Assistant Senior Board … more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Molina Healthcare (Omaha, NE)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
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