- Providence (Irvine, CA)
- **Description** **Claims Appeals Representative \*Remote * Candidates in AK, WA, MT, OR, CA or TX are encouraged to apply.** The Appeal and Grievance Specialist ... years Patient Accounting experience in a physician office, acute hospital, or medical collections. + 3 years Billing collections, or denials management experience… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and oversight of the ... Enterprise Member Appeals and Grievances Department. The Director is responsible for...director works closely with key internal stakeholders such as Medical Directors, Health Care Services, Operations, Marketing, Network Contracting,… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Trinity Health (Farmington Hills, MI)
- …organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer ... service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred. Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel. Completion of regulatory/mandatory… more
- State of Indiana (Indianapolis, IN)
- Appeals Law Clerk Date Posted: Apr 19, 2024 Requisition ID: 442495 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career with the State of ... a welcoming, accessible, and equitable workplace with a workforce that is representative of Indiana's population. As a proud equal opportunity employer, reasonable… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, April 1, 2024 Centers Plan for Healthy Living's goal is to ... JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse Determinations or Organization Determinations… more
- Edward M. Kennedy Community Health Center, Inc. (Worcester, MA)
- …expanding across sites to support this growth. We are currently hiring a Medical Billing Representative based in Worcester. This position follows department and ... ensure all claims are submitted in a timely and accurate manner. The medical billing representative analyzes and reviews outstanding accounts receivables and… more
- Robert Half Accountemps (Fort Wayne, IN)
- … Insurance Billing, Insurance Follow-up, Claim Denials, Denial Management, Insurance Denials, Medical Denials, Payer Denials, Medical Appeals , and Claim ... and Medical Denials * Expertise in handling Payer Denials and Medical Appeals * Familiarity with Claim Adjudication and Medical Insurance * Excellent… more
- CDPHP (Albany, NY)
- …invites you to be a part of that experience. The Provider Services Representative shall assume full responsibility and ownership for all aspects regarding education ... other providers regarding the proper utilization of the Plan. In addition, the representative will address and resolve service related issues including appeals … more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …all messages in a timely manner. + Maintains communication between medical providers, administrative staff, and/or patient/families. Business Services: + Assigns ... from insurance companies and re-files the claim. + Files appeals to carriers according to prescribed guidelines, documents all...up. + Scans and uploads patient clinical documents into medical chart. + Ensures all provider services are accounted… more
- Premier Medical Group of the Hudson Valley (Poughkeepsie, NY)
- JOB DESCRIPTION JOB TITLE: Insurance Follow up Representative DEPARTMENT/DIVISION: Billing STATUS: Full-time, Non-Exempt REPORTS TO: Billing Manager DATE: March 2024 ... POSITION SUMMARY: The Insurance Follow up Representative is responsible for collecting and resolving outstanding third party receivables, meeting productivity… more
- Veterans Benefits Administration (IN)
- Summary The Veterans Service Representative (Authorizer) will work as a member of the Decision Review Operations Center (DROC). Responsibilities Major Duties: ... as the primary contact for the veteran and his/her representative or advocate. The Veterans Service Representative ...questions relating to adequacy of military service, adequacy of medical evidence and lay testimony to establish a claim,… more
- Guidehouse (Lewisville, TX)
- …in customer service or Healthcare setting. . For insurance specific clients: 1+ year medical provider experience working with UB04, appeals & denials. . Strong ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...Account Review . Customer Service . Account Updates . Medical Billing . Strong Verbal / Written Communication Skills… more
- Beth Israel Lahey Health (Burlington, MA)
- …interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating ... the Billing Supervisor with the resolution of complex claims issues, denials, appeals and credits. 18. Completes projects and research as assigned. **Secondary… more
- Elevance Health (Plano, TX)
- …a check, or ask you for payment as part of consideration for employment. **Authorization Representative II - TX** + Job Family: CUS > Care Support + Type: Full time ... 15, 2024 + Reference: JR108973 **Location:** + TX, PLANO **Description** **Authorization Representative II - Texas** Location: **Hybrid, working two days a week… more
- Elevance Health (Las Vegas, NV)
- …or ask you for payment as part of consideration for employment. **Prior Authorization Representative II - Las Vegas, NV - BioPlus Specialty Pharmacy** + Job Family: ... or 1-hour commute each way of this location. The **Prior** **Authorization Representative II** is responsible for the administration of prior authorizations requests… more
- Guidehouse (Birmingham, AL)
- …composure. **What You Will Need** **:** + HS Diploma or equivalent. + 0-2 years medical provider experience working with UB04, appeals & denials. **What Would Be ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...Electronic Files + UB04's and 1500 Claim Files + Medical Record + Making outbound calls to Insurance Companies… more
- WellSpan Health (York, PA)
- Patient Financial Services Representative II Location: WellSpan Health, York, PA Schedule: Full Time Sign-On Bonus Eligible Remote/Hybrid Regular Apply Now See More ... account follow-up, researches claim denial for resolution and submits disputes and appeals . Represents the System in a professional manner while interacting with… more
- Guidehouse (San Antonio, TX)
- …in customer service or Healthcare setting. + For insurance specific clients: 1+ year medical provider experience working with UB04, appeals & denials. + Strong ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...Account Review + Customer Service + Account Updates + Medical Billing + Strong Verbal / Written Communication Skills… more
- Elevance Health (Altamonte Springs, FL)
- …for payment as part of consideration for employment. **Pharmacy Prior Authorization Representative - BioPlus Specialty Pharmacy** + Job Family: CUS > Care Support + ... Possibilities. Make an Extraordinary Impact.** The **Pharmacy** **Prior** **Authorization Representative ** is responsible for the administration of prior authorizations… more