- 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:… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Appeals and Recovery Support Specialist position investigates, examines and reviews claims' appeals , recoveries, and escalations in ... position communicates regularly with various levels of the organization to resolve appeals and escalations, serving as a valuable resource to various departments… 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
- 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 ...manner. This position will focus on quality review of non- clinical grievance and appeals cases for all… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… 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
- Trinity Health (Farmington Hills, MI)
- …location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned ... as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves… 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 ... of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of a team of...as to ensure timely follow-up and action for account appeals . + Works with Patient Access and other necessary… 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, ... attorney referral. * Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing deadlines. * Communicates all… more
- Rush Copley Medical Center (Aurora, IL)
- This position reviews initial clinical facility and physician denials, documents appeals or clinical inpatient denials, conducts appeals as appropriate. ... Track denial outcomes, identify trends and work collaboratively with clinical providers, coders, insurance companies and revenue cycle leadership to prevent future … more
- CVS Health (Hartford, CT)
- …independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 ... zone of residence. Position OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained...What you will do + Acts as a top-level specialist to implement best in class policies, plans, and… more
- Elevance Health (Woburn, MA)
- …grievance committees/hearings. + Summarizes and presents essential information for the clinical specialist or medical director and legal counsel. **Minimum ... **Grievance/ Appeals Representative II** **Location:** Hybrid 500 Unicorn Park...or outside consultant. + Triages clinical and non- clinical inquiries, grievances and appeals , prepares case… more
- Glens Falls Hospital (Glens Falls, NY)
- …but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to ... and Emergency coding Licenses, Certifications, Registrations CCS, RHIT, RHIA, Certified Coding Specialist is Required CDIP is a plus *Salary Range* The expected base… more
- BrightSpring Health Services (Louisville, KY)
- …be met. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors,...processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all… more
- Sodus Rehab & Nursing Center (Everett, MA)
- CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and benefit plans including: + Competitive Pay + Medical, Dental, Vision ... Package + Fun, Family-Like Team, and Atmosphere! We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ teams in Massachusetts.… more
- American Red Cross (Omaha, NE)
- …professionals. + Act as a consultant to external health care personnel about clinical apheresis. + Assess patient status relative to therapeutic apheresis, prior to ... alleviate human suffering. You can make a difference by volunteering in a position that appeals to you and allows you to use your unique skills and talents. The Red… more
- Houston Methodist (Houston, TX)
- … Specialist is responsible for coordinating and monitoring the coding specific clinical charges and denial management and appeals process in a collaborative ... environment with revenue cycle management and clinical partners at various Houston Methodist facilities. This position... subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- State of Colorado (Golden, CO)
- Social Worker/Counselor III (Behavioral Health Specialist ) - Golden Peak YSC in Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4418677) ... Apply Social Worker/Counselor III (Behavioral Health Specialist ) - Golden Peak YSC in Golden Salary $78,636.00...Division of Youth Services. Services to be provided include: clinical assessment (recognizing signs and symptoms of specific DSM-5… more
- State of Colorado (Greeley, CO)
- Social Work/Counselor III (Behavioral Health Specialist ) - Platte Valley YSC in Greeley Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4290264) ... Apply Social Work/Counselor III (Behavioral Health Specialist ) - Platte Valley YSC in Greeley Salary $78,636.00...growth and continued trainings, research and CEU's. Participates in clinical supervision with the clinical director. +… more