- Equitable (Charlotte, NC)
- Appeals Specialist , Disability Claims ( 25000066 ) **Primary Location** : UNITED STATES-NC-Charlotte **Other Locations** : UNITED STATES-Remote, UNITED ... help unlock your potential? Equitable is seeking an influential and dynamic Appeals Specialist to join our Disability and Absence Claims organization. The … more
- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, including any escalated step of… more
- HCA Healthcare (Frankfort, KY)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Appeals Specialist with Parallon you can be a part of an organization ... need to succeed in our organization. We are looking for an enthusiastic Appeals Specialist to help us reach our goals. Unlock your potential! **Job Summary and… more
- BJC HealthCare (St. Louis, MO)
- …experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist for infusions! Ideal applicants will have a patient ... Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level of… 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
- Intermountain Health (West Valley City, UT)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. Fully remote position! +… 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
- CenterLight Health System (NY)
- JOB PURPOSE: The Claim Appeals and Audit Specialist will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by timely and ... accurate processing of claims appeals and performing claims audit, ensuring payment integrity and...State, CMS, and contractual guidelines. This position emphasizes the appeals review and auditing of claims to drive process… more
- Centene Corporation (Sacramento, CA)
- …of California.** **Position Purpose:** Supports the documentation and processing of appeals , disputes and reconsiderations to ensure they are in accordance with ... Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals , disputes and reconsiderations are reviewed and processed timely. + Performs… more
- Community Health Systems (Sarasota, FL)
- **Job Summary** The Collections Specialist I is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ... ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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
- Molina Healthcare (New Haven, CT)
- …+ 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
- Providence (Renton, WA)
- **Description** The Compliance and Appeals Specialist position manages the USFHP Compliance and Integrity Program under the direction of the USFHP Senior Claims ... team and Claims Quality roles with CMS interpretation, coding, and claims queries/ appeals investigations The successful candidate in this role will be a proactive,… more
- Sutter Health (Sacramento, CA)
- …**Organization:** SMF-Sutter Med Foundation- Central **Position Overview:** The Grievances & Appeals Specialist RN supports the patient and family experience ... by addressing questions and offeringinformation, in support of patient-focused clinical services. Serves as liaison between patient and hospital staff while functioning as a patient advocate interfacing with patients, families, staff and hospital… more
- Presbyterian Homes and Services (Roseville, MN)
- …new donor records, record updates, database projects, report generation, and special appeals . The Foundation Specialist will also participate in ongoing training ... Overview Presbyterian Homes & Services Foundation is seeking a Foundation Specialist for its team. The Foundation Specialist is responsible for deadline-driven… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Administrative Support Staff** **Job Class: Office and Administrative Specialist , Senior** **Agency: Human Services Dept** + **Job ID** ... Dept / DHS Central Office AFSCME + **Division/Unit** : DHS - Central Office / Appeals Administrative Supv + **Work Shift/Work Hours** : Day Shift, 8:00am - 4:30pm +… more
- The County of Los Angeles (Los Angeles, CA)
- …Accountant I Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services ... Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services Assistant I Financial… 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
- 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
- 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 ... We are seeking an **_AR Revenue Cycle Specialist III_** who will be responsible for the...the basic collection of unpaid third-party claims and standard appeals , using various JHM applications and JHU/ PBS billing… more