- UnitedHealth Group (Sugar Land, TX)
- …Connecting. Growing together. The essential functions of a Senior Pharmacy PA/ Appeals Technician are providing expertise and customer service support to members, ... or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements,… more
- Movn Health (Los Angeles, CA)
- …Movn Health is seeking a highly experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This ... is a self-starter with a proven track record in A/R recovery, claim appeals , and payer follow-ups. Experience in startup environments and cardiovascular care is… more
- NewVista Behavioral Health (Cincinnati, OH)
- Job Address: 10123 Alliance Road, Suite 340Blue Ash, OH 45242 Accounts Receivable Specialist In conjunction with some of the areas most advanced physicians and ... clinical teams, Lynx EMS offers high quality medical transport...join an outstanding team! The Role The Accounts Receivable Specialist is responsible for overseeing the billing of all… more
- Strategic Health Partners (Kennesaw, GA)
- …insurance companies by working with assigned payers. *Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, ... and/or resolving appeals with third-party payers. Research and resolve payer rejected/denied...for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials.… more
- Ultimate (Tarpon Springs, FL)
- …Ultimate Staffing Services is actively seeking a detail-oriented Medical Insurance Collections Specialist to join their client's team in Florida. This role is ... claims, and maintaining compliance with federal and state regulations. The specialist will collaborate with insurance carriers, patients, and internal departments to… more
- Axelon Services Corporation (Hometown, IL)
- Job Description: Disability Claims Specialist MAX PAY RATE - $42 per hour Fully Remote 10-20 hours per week Must have at least 3+ years prior LTD/IDI Insurance ... with both external and internal resources, such as physicians, attorneys, clinical /vocational consultants as needed to gather data such as medical/occupational… more
- Camen Behavioral Services (Orlando, FL)
- …others? Join our growing team at Camen Behavioral Services as a Medical Billing Specialist and help us continue making a difference in the lives of children and ... children with autism and developmental needs. Our team is driven by clinical excellence, compassion, and collaboration in everything we do. Key Responsibilities… more
- CarolinasDentist (Raleigh, NC)
- …insurance claims and balances; working problem EOBs, denials, and processing appeals as needed. Responsibilities Core Responsibilities: Reviews clinical note, ... to the dental office or assigned to the designated clinical team member within PMS with the expectation that...dental office. Files corrected claims triaged from the AR Specialist based on returned problem EOBs Manages Accounts Receivable… more
- Brightstar Care of Ft. Myers/Naples (Naples, FL)
- …We are looking for the an experienced medical Billing and Payroll Specialist . Responsibilities include weekly processing of billing and payroll.. Managing ... Authorizations , appeals and re- submission of claims . Posting cash...Employer matching Insurance: Medical Dental Vision Mileage Reimbursement for clinical / administrative positions Employee Assistance Program Generous Paid… more
- Rochester Regional Health (Newark, NY)
- …the medical management department in the tracking, trending and reporting of appeals and charge recovery information. Conducts reviews of cost outliers and ... Provides ongoing support for the tracking and trending of the Reimbursement Specialist charge recovery activities. Assists with special projects including but not… more
- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist , is responsible for managing client medical ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… 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 Quality Auditing Specialist II Job Category: Accounting/Finance Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...manner. This position will focus on quality review of non- clinical grievance and appeals cases for all… 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 ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your… 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
- Elevance Health (Irving, TX)
- …our specialty pharmacies, our infusion centers, and the home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - ... weeks/30 days at the Plano, TX office. The **Referral Specialist II** is responsible for providing support to a... II** is responsible for providing support to a clinical team in order to facilitate the administrative components… more
- Molina Healthcare (Midvale, UT)
- …position, home office with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct ... for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of… 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 ... Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that… more
- LA Care Health Plan (Los Angeles, CA)
- …Prepares template determination/education letters for members and providers. Duties Provide non- clinical support to the Customer Solution Center Appeals and ... obtaining clarification on initial responses. (25%) Under the supervision of the Appeals and Grievance Manager, assist with soliciting non- clinical information… more
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