- Alight (TX)
- …at careers.alight.com. **Job Summary** Do you want to be part of a collaborative Appeals team? The Appeals Specialist is responsible for reviewing adverse ... determinations for Short Term Disability and Long-Term Disability (STD/LTD) claims. The Appeals Specialist will determine the appropriate claim determination on… more
- 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
- 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 ... identified during the billing of claims and the follow-up on the clinical appeals performed by the facilities. Key Responsibilities include: + Responsible for … 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 ... in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety of… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- WelbeHealth (CA)
- …claims leadership and other internal and external stakeholders, the Claims Audit and Appeals Specialist will be accountable for managing second level provider ... and respond to provider claim related issues and second level disputes and appeals + Coordinate the receipt, tracking, and review, of invoices related to claims… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… 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 team player who is responsible for… more
- Lincoln Financial Group (Columbus, OH)
- …#:** 73054 **The Role at a Glance** We are excited to bring on an Appeals Specialist to join our Appeal Review Department in a fully remote environment. ... management and appeal procedures to each claim. _Background Details_ As an Appeals Specialist you will be responsible for being a product subject matter expert… more
- Robert Half Accountemps (Long Beach, CA)
- …experiences. To augment our dedicated team, we are seeking an experienced Medical Appeals and Grievance Specialist . Position Overview: In this role, you will ... be responsible for reviewing, investigating, and resolving various appeals and grievances related to medical care, services, and our health plans. We are searching… 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Randstad US (Dallas, TX)
- medical appeals and denials specialist . + dallas , texas + posted february 2, 2024 **job details** summary + $20 - $20.93 per hour + temp to perm + high school + ... deadlines. .Ability to research denials .Ability to compose and file appeals /reconsiderations .Managed care, Medicaid and Commercial follow-up .Familiar with a… more
- ManpowerGroup (Columbia, SC)
- …500 American global company that is engaged in the discovery, development. ** Specialist , Appeals ** **3-month contract with high possibility of extension** **Pay ... rate: 17 $/hr - max** **Columbia SC 29229** **Revert back with your resume if interested at ###@experis.com** **Job Descripition:** Performs non-medical reviews and processes redetermination letters. * 50% Performs non-medical reviews and processes… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management/ Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered...Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to… 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...Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training… more
- Beth Israel Lahey Health (Charlestown, MA)
- …**Scheduled Hours:** 40 **Work Shift:** Day (United States of America) **The Denials Specialist role is eligible for a $1,500 sign on bonus.** **This position is ... early as 7-3:30PM) with a comprehensive benefit program.* **Job Description:** The Denials Specialist position is a key role on our expansive Revenue Cycle Team. As… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials/ appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for A/R, ... Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing...Responsible for timely medical records requests and submission of appeals * Maintain adequately trained staff to achieve daily… more
- TEKsystems (Columbia, SC)
- …+ Performs non-medical reviews and processes redetermination letters. + Performs non-medical reviews and processes redetermination letters ensuring timeliness and ... accuracy. + Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools. + Updates letters and documents within the department when necessary. + May gather and prepare documentation for legal inquiries and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and… more
- Randstad US (Columbus, OH)
- …job details Our client, a large health care company, is looking for a Grievance and Appeals Specialist in the Columbus, OH area to support a Hybrid Role. Please ... grievance and appeals (columbus, oh only). + columbus , ohio...AM - 5 PM education: High School Responsibilities Pulling appeals from the workbasket, reviewing claim denials, setting up… more