- Monster (Lake Success, NY)
- …network experience within revenue cycle performing insurance follow-up calls investigating medical claims Submitting appeals Researching denied claims ... paid. The Opportunity Join our collaborative team handling surgical and out-of-network claims , appeals , denials, and overall reimbursement recovery. This role is… more
- Monster (North Haven, CT)
- …billing, patient, and payor-related issues. Handle escalated complaints and resolve complex claims , appeals , and reconsiderations, while guiding staff on next ... entry staff. Obtain purchase orders and invoices for implants to submit to insurance companies. Work directly with payors and health plans to resolve revenue cycle… more
- Martin's Point Health Care (Portland, ME)
- …with Medical Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts routine data evaluation for ... been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This role… more
- AmeriHealth Caritas (Newark, DE)
- …of member and/or provider appeals , the analysis of claims and appeals , and the review of medical management authorizations.; + Research and Investigate ... counterparts as needed to ensure proper handling of the appeal eg UM team, medical directors, claims , contact center, vendors as needed (eg PerformRX) + Creates… more
- TEKsystems (Jacksonville, FL)
- …cause analysis, EHR, EMR, EPIC, Cerner, medical billing, claims audit, appeals process, appeals letter, denials, insurance follow ups Top Skills ... claims are denied - determine where to send appeals - determine whether a claim needs to be...Details revenue cycle appeal,revenue cycle specialist,denials specialist, appeals specialist, insurance follow up Pay and Benefits… more
- Point32Health (MA)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... service or member services representative in health care or insurance + Preferred: 2 years' Appeals and...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- R1 RCM (Chicago, IL)
- … process, ensure compliance with payer policies and regulations, and negotiate with insurance companies to resolve disputed claims . + Collaborate with other ... transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ... position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations,… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
- TEKsystems (Austin, TX)
- …+ Revenue cycle appeal and denial resolution + Insurance follow-up and claims audit + Appeals letter writing and submission + EMR/EHR experience (Epic, ... role is ideal for someone with strong experience in appeals , denials, and insurance follow-up within the...cause analysis to determine next steps. 2. Rebilling & Appeals Submission + Focus on claims ready… more
- Centene Corporation (Phoenix, AZ)
- …Dispute experience preferred **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution ... school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims , related managed care experience, or relevant experience. Pay… more
- CVS Health (Harrisburg, PA)
- …meetings when required. * Understands and can respond to Executive complaints and appeals , Department of Insurance , Department of Health or Attorney General ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- Point32Health (Canton, MA)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- MTA (Brooklyn, NY)
- Executive Agency Counsel, Appeals Job ID: 12747 Business Unit: MABSTOA Location: Brooklyn, NY, United States Regular/Temporary: Regular Department: Torts Date ... 27, 2025 Description Job Information Executive Agency Counsel, Non-Managerial (Level A & B)- Appeals First Date of Posting: 8/19/2025 Last Date of Posting: Open Until… more
- Molina Healthcare (Omaha, NE)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific… more
- Evolent (Phoenix, AZ)
- …and health plan guidelines. + Conduct research and analysis of case documentation, claims data, and medical records to ensure case files are complete. ... the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator** **,** ** Appeals and Grievances** at Evolent will serve as a point of contact for… more
- Elevance Health (Indianapolis, IN)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... implications for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to… more
- Humana (Topeka, KS)
- … Medical Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems ... Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Responsible for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): ... root/cause analysis when required. The Analyst will work with HAP's medical directors, nurses, pharmacists, Legal department, and other subject matter experts… more
- Humana (Honolulu, HI)
- …Corporate Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on ... + Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. +… more
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