- Universal Health Services (Reno, NV)
- …Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, ... processing and responding to written member and provider complaints, appeals , and grievances. This position is required to apply analytical and critical thinking… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Universal Health Services (Richmond, VA)
- …Rico and the United Kingdom. The Atlantic Region CBO is seeking a dynamic and talented Appeals Specialist . The Appeals Specialist is responsible for the ... relating to technical issues identified during the billing of claims and the follow-up on the clinical appeals... claims and the follow-up on the clinical appeals performed by the facilities. Key Responsibilities include: +… more
- Trinity Health (Farmington Hills, MI)
- …as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves ... payment delays and/or variances resulting from rejected and/or denied claims and/or overpayments and underpayments with direction from the Supervisor Payment… more
- Robert Half Accountemps (Long Beach, CA)
- Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible for ... managing all grievances, appeals and complaint processes related to medical services. You...in handling Medical Grievances * Demonstrable knowledge in Medical Claims * Proven ability in managing Insurance Claims… more
- Molina Healthcare (Milwaukee, WI)
- …agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
- Trinity Health (Farmington Hills, MI)
- …Maintains knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues ... resolves payment delays and/or variances resulting from rejected and/or denied claims and/or overpayments and underpayments. Processes payments as appropriate in… more
- Generac Power Systems (Waukesha, WI)
- ** Appeals & Grievances Specialist I** **Company** Generac Power Systems **Name** Appeals & Grievances Specialist I **Req #** 64663 **Employment Type** ... and enjoy a fast-paced, high-performance culture. **Job Summary:** The Appeals and Grievances Specialist is a critical...equivalent + 1 year experience in escalations, resolutions or claims **Nice to Haves:** + Previous experience using SAP… more
- Universal Health Services (Bonham, TX)
- …day. TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare ... payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II...and recommends updates on policy and procedure critical to claims process. Perform other duties as assigned. Duties Continued… more
- Randstad US (Dallas, TX)
- medical appeals and denials specialist . + dallas , texas + posted 9 days ago **job details** summary + $20 - $20.93 per hour + temp to perm + high school + ... further. Must have at least 2 years of backend appeals and denials experience. salary: $20 - $20.93 per...Billing + ICD-10 + Medical Billing - Denials + Claims Processing + HIPAA Qualifications + Years of experience:… more
- University of Michigan (Ann Arbor, MI)
- …support coding and billing processes. ** Appeals ** : Prepare and submit appeals for denied claims , providing necessary documentation and supporting evidence ... Inpatient Coding and Appeals Coordinator - Remote Apply Now **How to...**Responsibilities **Denial/Audit Analysis** : Review and analyze denied inpatient claims and external audit opportunities to identify the root… more
- Medical Mutual of Ohio (OH)
- …of education/training and experience. . 7 years progressive experience as an Appeals /Customer Resolution Specialist or equivalent experience in customer service ... Supervises operations and staff responding to written/verbal grievances, complaints, and appeals submitted by commercial or government health plan members and… more
- Billings Clinic (Billings, MT)
- …Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Claims Specialist I (Full-time/Billings) PATIENT ... claims from government and third-party payers. The Claims Specialist is responsible for preparing and...of refunds, if appropriate, and coordinating adjustments, when necessary, claims appeals or resubmissions, moving balances from… more
- Illumination Foundation (Santa Ana, CA)
- …across Orange County, Los Angeles County and the Inland Empire. Job Description The Claims Specialist is responsible for accuracy of claims submission, ... benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts… more
- TEKsystems (Wausau, WI)
- Medical Billing & Claims Specialist Location: + Wausau, WI + Job is 100% on-site Hours: + M-F 8am-5pm Description: + A Medical Billing & Claims Specialist ... Clinic and Surgery Center. + Follow up on unpaid claims . + Process credit balances within a timely manner....timely manner. + Research account denials and file written appeals when necessary. + Check each insurance payment for… more
- Office of Personnel Management (Washington, DC)
- Summary As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be part of Healthcare and Insurance, Office of Personnel Management. ... from Postal enrollees and/or their authorized representatives, including responses on appeals of disputed health benefit claims , benefits regulations, and… more
- TEKsystems (Wausau, WI)
- Description: A Medical Billing & Claims Specialist is responsible for working and managing Accounts Receivable for our Clinic and Surgery Center and providing ... contract requirements. Monitor insurance accounts receivable Follow up on unpaid claims . Process credit balances within a timely manner. Research account denials… more
- Robert Half Accountemps (Costa Mesa, CA)
- …payments and accounts. The successful candidate will be responsible for evaluating claims , initiating appeals for underpayments, reviewing and completing payor ... Description We are looking for a Medical Collections Specialist to join our team in Costa Mesa,...actions taken in the appropriate systems. Responsibilities: * Evaluate claims at the contract rate for proper pricing *… more
- Robert Half Accountemps (Fort Wayne, IN)
- …are offering a contract to permanent employment opportunity for an Insurance Follow-Up Specialist in FORT WAYNE, Indiana. This role is in the healthcare industry and ... will involve follow-ups on medical claims . The workplace environment is business casual and requires...Manage Insurance Denials and Payer Denials, and handle Medical Appeals . * Leverage expertise in Insurance Follow-up, Claim Denials,… more