- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue Cycle Denials Management… more
- PharmaCord (Jeffersonville, IN)
- …it to our Talent Acquisition team immediately at ###@pharmacord.com This is a hybrid/ remote eligible role. Candidates may be eligible for a hybrid schedule (50% in ... office, 50% remote ) once training is successfully completed (training program usually lasts about 90 days on average). Candidates may be eligible for a remote … more
- PharmaCord (Jeffersonville, IN)
- …A typical day in the life of a Medical Billing and Coding Specialist will include the following: The responsibilities include, but are not limited to ... provide education support for the office to submit pre-determinations, appeals and/or peer to peer reviews with payors, as...eligible for a hybrid schedule (50% in office, 50% remote ). To qualify for a hybrid schedule, you are… more
- Molina Healthcare (IA)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides ... **Essential Job Duties** + Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals correspondence, and determination of next ... without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related… more
- Molina Healthcare (MI)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals … more
- Molina Healthcare (Columbus, GA)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Appeals Specialist II - RN, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for ... to facilities regarding denials that are resulting in retractions. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll play… more
- Cognizant (Lincoln, NE)
- **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... 44, MOON, Connecticut notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. *… more
- University of Michigan (Ann Arbor, MI)
- …Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals Specialist has a strong knowledge of medical appeal and audit ... They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain… more
- Molina Healthcare (OH)
- **Job Description** This role is remote to candidates who live in Ohio. There will be some travel (up to 20% +/-) within the state of Ohio. This role will act as an ... Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the… more
- Beth Israel Lahey Health (Burlington, MA)
- …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands-on coding, documentation review, and other coding needs for ... with the resolution of complex claims issues, denials, and appeals . 16. Completes projects and research as assigned. 17....Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA) Experience: 2 - 3… 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
- Spectrum Billing Solutions (Skokie, IL)
- …We are looking to add a passionate and skilled Revenue Cycle AR Collections Specialist to our growing team. The ideal candidate will use their skills and knowledge ... includes all aspects of revenue cycle collections including denial management, appeals , reimbursement rate negotiation, and accounts receivable collections. This is… more
- State of Colorado (Denver, CO)
- …/ Child Welfare Involved Youth Prevention Services Specialist (SSSIII) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5120120) Apply Juvenile ... / Child Welfare Involved Youth Prevention Services Specialist (SSSIII) Salary $58,872.00 - $78,000.00 Annually Location Denver...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Independent Health (Buffalo, NY)
- …fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical decisions on ... They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise...audit tips across the team. The Clinical & Coding Specialist -Senior will support the leadership in Hospital Audit in… more
- State of Colorado (Denver, CO)
- …Management & Outcomes (PMO) Residential Specialist IV Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115383) Apply Performance Management ... & Outcomes (PMO) Residential Specialist IV Salary $71,544.00 - $91,200.00 Annually Location Denver Metro, CO Job Type Full Time Job Number IHA 07248 10/17/2025… more
- LA Care Health Plan (Los Angeles, CA)
- …Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist ** **Location: Fully remote ** **Duration: 12 months contract** **Job Description:** + Prior Authorization ... Specialist takes in-bound calls from providers, pharmacies, members, etc...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
