- PharmaCord (Jeffersonville, IN)
- …for coverage and provide education support for the office to submit pre-determinations, appeals and/or peer to peer reviews with payors, as applicable Assist offices ... to understand payor denied or underpaid claims and provide education, as applicable, for the office to resolve of rejected, denied or underpaid claims Educate HCPs, their office staff and/or patients on appropriate resources for questions about co-pay,… more
- unifyCX (San Antonio, TX)
- …industry (preferred but not required). What Will You Do? Take ownership of appeals and claims, investigating and analyzing each case to determine the best path ... forward. Communicate policy guidelines and decisions to customers with clarity, empathy, and professionalism. Collaborate with the team to resolve complex cases and maintain seamless case management. Balance customer satisfaction with policy compliance,… more
- Universities of Wisconsin (Whitewater, WI)
- …accommodations for students with disabilities and serve as University Housing representative on the accommodations committee for CSD. Work collaboratively with ... complicated and sensitive housing-related issues, policy questions, requests, and appeals , including matters related to student resident disabilities and gender… more
- Humana (Louisville, KY)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... an a grievance, appeal or further request is warranted. Job Description The Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- CenterWell (Helena, MT)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- AmeriHealth Caritas (Philadelphia, PA)
- …about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances, this position is responsible for the ... administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals ,... system and documents, all correspondence with a member/participant, representative and/or a provider, related to an appeal or… more
- HANAC, Inc. (Astoria, NY)
- …integral part of a team with the immigration attorney, Board of Immigration Appeals (BIA) accredited representative , and support staff. The Immigration Paralegal ... will assist the staff attorney and the Program Director in providing legal services, education, and outreach, including coordination of community events, and working under attorney supervision to assist clients on Immigration law matters. The Paralegal will… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for ... billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity… more
- US Tech Solutions (Myrtle Beach, SC)
- …Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work experience. C2 clearance ... as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following organizational… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY The Patient Financial Services Representative supports the mission of providing quality healthcare to the patients of WhidbeyHealth by performing a ... support the financial health and well-being of the organization. The PFS Representative may be responsible for coordinating patient referrals and subsequent follow… more
- CDPHP (Latham, NY)
- …invites you to be a part of that experience. The Customer Care Representative shall assume full responsibility and ownership for all aspects regarding education of ... advise the customer of their rights and responsibilities. The Member Service Representative will work closely with all departments, such as Marketing, Enrollment,… more
- Guidehouse (Birmingham, AL)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The Central Denials ... Account Representative conducts thorough account reviews to determine the appropriate...resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/Manager as needed with various projects.… more
- New York State Civil Service (Albany, NY)
- …rules, regulations and case law. The incumbent serves as the Chancellor's representative in hearing appeals of disciplinary and contract grievances pursuant ... policy for classified service employees.- Serves as the University's representative in the administration of the grievance procedures (contract, non-contract… more
- Independent Health (Buffalo, NY)
- …culture that fosters growth, innovation and collaboration. **Overview** The Servicing Representative is a customer service professional who displays confidence, a ... listening towards all Pharmacy Benefit Dimensions (PBD) customers. The Servicing Representative functions as an advocate for all customers and resolves all… more
- US Tech Solutions (Myrtle Beach, SC)
- …and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following ... guidelines. **Responsibilities:** + Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining… more
- Stanford Health Care (Palo Alto, CA)
- …is a Stanford Health Care job.** **A Brief Overview** The Patient Account Representative (PAR) is responsible for the timely and accurate processing of insurance ... - Payer clerical and technical denial review and request processing including basic appeals - Payment posting and batch reconciliation - Credit balance review and… more
- CVS Health (IL)
- …Service group. Responsibilities below include, but not limited to: Customer Service Representative is the face of Aetna and impacts members' service experience by ... new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates providers on our self-service… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role The Customer Service Representative assists members, physicians, hospitals, and other healthcare providers with member benefits, eligibility, and ... appeals . The Customer Service Representatives must be able to...high-volume call center, experience with medical specialties, complaints and appeals and call center responsibilities. Previous experience in a… more
- Guidehouse (Birmingham, AL)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The Patient Account ... Representative (PAR) is expected to perform specific billing processes,...taking necessary actions to obtain account resolution. + Submits appeals , as appropriate, for all non-clinical denials + Monitors… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management ... securing signatures on the form from the patient or their legal representative , and answering questions regarding the appeal process + Distributes the Medicare… more
