- State of Colorado (Denver, CO)
- DD Waiver Enrollment & Appeals Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5159953) Apply DD Waiver Enrollment & Appeals ... care and driving value for Colorado. We are looking for aDD Waiver Enrollment & Appeals Specialist to join our Office Of Community Living ! As part of the State… more
- TEKsystems (Denver, CO)
- Medical Appeals Specialist (Fully Remote) Make a measurable impact by overturning denials, recovering missed revenue, and improving patient account outcomes. As ... a Medical Appeals Specialist , you'll combine deep payer policy knowledge with analytical problem‑solving-owning complex research, writing strategic appeals ,… more
- Intermountain Health (Montgomery, AL)
- **Job Description:** The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance ... Physician Advisor and works with them to obtain support for appeals . + Collaborates with Care Management, Physician Advisors, Revenue Integrity, Compliance,… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- CommonSpirit Health (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
- Community Health Systems (Franklin, TN)
- …and supports initiatives that improve denial prevention and recovery processes. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, ... **Job Summary** The Appeal Specialist II reviews, analyzes, and resolves insurance denials...and communicates payer updates to relevant stakeholders. The Appeal Specialist II collaborates with internal teams to ensure timely… more
- Modivcare (Ridgeland, MS)
- …be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is responsible for establishing ... superior customer service and to reduce the number of official complaints through positive and effective working relationships with customers, providers, and agencies. This role will work identify root causes of issues and provide real time solutions for… more
- Robert Half Legal (Mountlake Terrace, WA)
- …Robert Half is partnering with a Healthcare Organization searching for their next appeals specialist . This is an excellent opportunity for a motivated ... professional who thrives in a fast-paced environment. They are looking for someone to join ASAP! Location: Remote Pay Rate: $21-23 per hour Duration: 3+ months potential for extension Schedule: M-F, 8am-5pm Responsibilities: + Research, coordinate, and resolve… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... diagnosis and procedure codes to assure properly assigned MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... 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
- Health Care Service Corporation (Tulsa, OK)
- …Is Responsible For Processing And Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements ... In Writing, To All Inquiries Involving Member*S Requests For Appeals . May Train And Mentor Less Experienced Appeals... Appeals . May Train And Mentor Less Experienced Appeals Specialists. THIS IS NOT A FULLY REMOTE POSITION.… more
- Mayo Clinic (Rochester, MN)
- …coding-related denials. Experience in utilization review, case management, denials and appeals , revenue cycle, or prior authorization preferred. Knowledge and use of ... of care criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge and use of payer medical policy… more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... and intensity of services provided. + Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not… more
- Nuvance Health (Danbury, CT)
- …44, MOON, Connecticut notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * ... Assists with informing Managed Care contracting team with necessary contractual language to protect organization financial position specific to inpatient medical necessity requirements. * Employs creative solutions with team members and leadership to prevent… more
- McLaren Health Care (Mount Pleasant, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- Nuvance Health (Danbury, CT)
- …*Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders ... role is instrumental in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for the Nuvance Health… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... Collaborate with clinical staff and coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed records in the… more
- Molina Healthcare (San Antonio, TX)
- …and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- Molina Healthcare (Bowling Green, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more