- 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
- PharmaCord (Jeffersonville, IN)
- …team immediately at ###@pharmacord.com A typical day in the life of a Medical Billing and Coding Specialist will include the following: The responsibilities ... changes, and appropriate claims submission processes Educate offices about the medical necessity requirements for coverage and provide education support for the… more
- PharmaCord (Cincinnati, OH)
- …communicating clearly, focusing on the accuracy of the details of their medical records, your mastery of the program requirements, and ensuring their prescriptions ... includes completing benefit investigations, tracking prior authorizations / denial appeals , and assisting patients or other callers/stakeholders through resolution… more
- The Crucible (Oakland, CA)
- …following roles: an office manager, HR generalist, administrative support specialist , full-charge bookkeeper or purchasing coordinator. Intermediate to advanced ... the month following 30 days of service. Benefits include: Medical , dental and vision coverage at 50% for employees...fit, what you'd bring to The Crucible and what appeals to you about this position. Due to the… 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 ... the services/treatment rendered. JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for diagnosis and procedure code assignment and… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and ... /grievance filings, and in administrative hearing proceedings. Duties Include: + The Appeals and Grievance Specialist is responsible for managing and resolving… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. ... The Clinical Denials Prevention & Appeals Specialist plays a critical role in...validation issues by leveraging comprehensive knowledge of clinical documentation, medical coding (with special emphasis on ICD-10), payer policies,… 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 ... a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based...determine if an appeal is warranted. + Formulate clinical appeals and letters of medical necessity to… 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 ... with Medical Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts routine data evaluation for… 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 ...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- McLaren Health Care (Mount Clemens, MI)
- … demonstrating accuracy/proficiency in referencing support from the medical recorddocumentation and coding guidelineswith timely and successful submissions. ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- Molina Healthcare (Everett, WA)
- …DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… more
- Actalent (Dallas, TX)
- Job Title: Specialist , Appeals & GrievancesJob Summary: Responsible for reviewing and resolving member and provider complaints and communicating resolutions. Key ... + Use internal systems to determine outcomes of claims appeals and grievances. + Review medical records and billing details to formulate conclusions. + Ensure… more
- Molina Healthcare (IA)
- …+ 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
- Cognizant (Phoenix, AZ)
- …the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Lincoln Financial (Denver, CO)
- …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
- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for ... cycle or business office required + 1-3 years experience in healthcare insurance medical billing preferred **Knowledge, Skills and Abilities** + To perform this job… more
- Nuvance Health (Danbury, CT)
- …with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role ... payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review,...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- TEKsystems (Columbia, SC)
- …ENTRY POSITION, LOOKING FOR COMPUTER AND DATA PROCESSING EXPERIENCE. Performs non- medical reviews and processes redetermination letters. *50% Performs non- medical ... the benefits available for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement… more
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