- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue Cycle Denials Management… more
- PharmaCord (Cincinnati, OH)
- …report it to our Talent Acquisition team immediately at ###@pharmacord.com This is a remote role. Candidates must reside in the state of Ohio. When you join the ... includes completing benefit investigations, tracking prior authorizations / denial appeals , and assisting patients or other callers/stakeholders through resolution… more
- PharmaCord (Jeffersonville, IN)
- …A typical day in the life of a Medical Billing and Coding Specialist will include the following: The responsibilities include, but are not limited to ... provide education support for the office to submit pre-determinations, appeals and/or peer to peer reviews with payors, as...eligible for a hybrid schedule (50% in office, 50% remote ). To qualify for a hybrid schedule, you are… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals correspondence, and determination of next ... without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related… more
- Cognizant (Washington, DC)
- **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Molina Healthcare (MI)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals … more
- Molina Healthcare (Columbus, GA)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… 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 ... to facilities regarding denials that are resulting in retractions. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll play… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... 44, MOON, Connecticut notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. *… more
- University of Michigan (Ann Arbor, MI)
- …Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals Specialist has a strong knowledge of medical appeal and audit ... They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... review. Provides billing with information needed to obtain payment of claims. Remote within local geography after orientation. JOB DUTIES AND RESPONSIBILITIES: +… more
- Community Health Systems (Fort Smith, AR)
- **_Job Summary_** _The Remote Insurance Reimbursement Specialist is responsible for processing, reviewing, and verifying reimbursement claims to ensure accuracy, ... with payer guidelines while maintaining productivity and accuracy standards._ _As a Remote Insurance Reimbursement Specialist at Community Health Systems (CHS) -… more
- Marshfield Clinic (Marshfield, WI)
- …missions in the world!** **Job Title:** Reimbursement Auditing Specialist ( Remote in Wisconsin) **Cost Center:** 101651059 Coding-Audit Appeals Educ ... residents only eligible to apply**_** **JOB SUMMARY** The Reimbursement Auditing Specialist assists personnel in various areas of Revenue Integrity/Revenue Cycle as… more
- Beth Israel Lahey Health (Burlington, MA)
- …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands-on coding, documentation review, and other coding needs for ... with the resolution of complex claims issues, denials, and appeals . 16. Completes projects and research as assigned. 17....Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA) Experience: 2 - 3… 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
- State of Colorado (Denver, CO)
- …/ Child Welfare Involved Youth Prevention Services Specialist (SSSIII) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5120120) Apply Juvenile ... / Child Welfare Involved Youth Prevention Services Specialist (SSSIII) Salary $58,872.00 - $78,000.00 Annually Location Denver...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Independent Health (Buffalo, NY)
- …fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical decisions on ... They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise...audit tips across the team. The Clinical & Coding Specialist -Senior will support the leadership in Hospital Audit in… more
- State of Colorado (Denver, CO)
- …Management & Outcomes (PMO) Residential Specialist IV Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115383) Apply Performance Management ... & Outcomes (PMO) Residential Specialist IV Salary $71,544.00 - $91,200.00 Annually Location Denver Metro, CO Job Type Full Time Job Number IHA 07248 10/17/2025… more
