- Option Care Health (Columbus, OH)
- …with Billing and Collection Training and completes "second level" appeals to payers.Job Description: Job Responsibilities:Submits timely, accurate invoices to ... payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized… more
- Cambia Health Solutions, Inc (Tacoma, WA)
- Appeals Specialist IRemote within WA, ID, OR, and UTPrimary Job Purpose:Responsible for all activities associated with requests for Provider Billing Disputes and ... Appeals . Includes analysis, preparation, evaluation of prior determinations, coordination of clinical review if needed, decision making, notification, and completion.… more
- A-Line Staffing Solutions (Sacramento, CA)
- Grievance and Appeals Coordinator opening available with a major Healthcare Corporation in the Sacramento CA 95834 area! Highlights: Schedule: Monday-Friday 8:00am- ... written and critical Skills Preferred Requirements: Previous Grievance and Appeals experience preferred Medical management, utilization management or experience… more
- Accounting Now (Tampa, FL)
- Medicare Appeals Specialist Do you like challenging payers? Enjoy that feeling of satisfaction when your appeal is overturned? Then, this position may is right for ... you! The ideal candidate will be well versed in the Medicare managed care appeals and grievance process. Must have strong knowledge of Medicare payer guidelines and… more
- MultiPlan (Atlanta, GA)
- …communication of a client issue and analyze, research and resolve claim appeals through effective use of provider contract rates and fee schedule reimbursement ... negotiate successful resolution of issue to ensure no reoccurring appeals for the issue. Reprice or adjust facility and...issue. Reprice or adjust facility and progessional claims or appeals . Responsible for running claim reports to determine the… more
- Blanchard Valley Health System (Findlay, OH)
- …of productivity to effectively reduce days in A/R. Develops and writes appeals for denials associated with the payment of claims within the department/division. ... Maintains appropriate timeliness of appeals for denials. Identifies other means and resources to...A/R and payer issues, avoid timely claim consideration/filing, failed appeals , and/or increased denials & write-offs. Participates in and… more
- Accounting Now (Tampa, FL)
- …advanced-level work related to clinical and coding denial management and appeals follow-up. The individual is responsible for conducting a comprehensive review ... to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely manner. This...fax, etc Documents and summarizes all rationale for all appeals in EPIC. Documents communications with medical office staff… more
- A-Line Staffing Solutions (Cleveland, OH)
- …Nurse, Travel RN, Home Health Nurse, Home Health RN, Grievance and Appeals , Denials, MCO, CCM, InterQual, ICD-10, URAC, CMS, Medicare, Medicaid, Case Management, ... Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals , Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient… more
- Accounting Now (Pinellas Park, FL)
- …companies on unpaid insurance accounts identified through aging reportsAble to identify an appeals worthy claim and or ability to process appeals online or ... insurance accounts identified through aging reportsAble to identify an appeals worthy claim and or ability to process ...appeals worthy claim and or ability to process appeals online or via paper submission; Assist with billing… more
- Mindlance (Columbia, SC)
- …as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following organizational ... department guidelines. *45% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining… more
- Spectraforce Technologies Inc (Columbia, SC)
- …and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following ... department guidelines. 40% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining… more
- Southeast Georgia Health System (Brunswick, GA)
- …a timely manner. Demonstrates proficiency in preparation and follow-up of denial appeals . Maintains denial spreadsheet report-keeps it current & accurate by payer. ... are conducted as outlined in the Utilization Plan. Coordinates patient's appeals to the Quality Improvement Organization (QIO) ensuring timely medical record… more
- Penske Truck Leasing Co., LP (Reading, PA)
- …or manager with operating tax compliance processes including rendition/return filing, appeals and abatements and refund/bill entry. * Be able to understand ... or manager with operating tax compliance processes including rendition/return filing, appeals and abatements, bill entry for operating tax * Analyze processes,… more
- Abbtech Professional Resources (Washington, DC)
- …of criminal litigation, including pretrial discovery, motions, hearings, trials, and appeals . * Reviews and analyzes documents, transcripts, files, and other ... materials to locate information and evidence relevant to investigative actions or responsiveness to grand jury subpoenas. * Uses electronic databases to perform litigation support tasks, including reviewing, organizing, indexing, tagging, and summarizing… more
- Cambia Health Solutions, Inc (Renton, WA)
- …reviews)Understanding of claims, billing and codingFacets/claims systems in appeals , SIUClaims processing, claims configuration rolesUnderstanding of Medical and ... reimbursement policiesCPC Certified or willing to get CPC Certified as condition to position.Normally to be proficient in the competencies listed belowPolicy and Implementation Analyst would have a Bachelor's degree in Business Administration or a related… more
- George Washington University (Washington, DC)
- …software. Logs, tracks, and segments donors and donations for future appeals . Continuously seeks opportunities for improvement in financial practices and internal ... controls and implements new policies and procedures where appropriate to safeguard the Center's funds. Ensures existing policies and procedures are followed while ensuring optimum levels of internal controls. Maintains current listings on GuideStar and… more
- Cambia Health Solutions, Inc (Boise, ID)
- …medical exception requests, prior authorization requests, reconsiderations, and appeals . Prepares reconsideration requests for Clinical Pharmacy Consultant review ... by obtaining and organizing appropriate documentation, including, but not limited to medical chart notes/reports and medication profiles. Communicates (orally and by written documentation) information and determinations to providers and members as… more
- Axelon Services Corporation (Highland Beach, FL)
- …appropriate discharge plan, care plan, and coordination of acute care and long term care services * Assist member with filing and resolving complaints and appeals ... This position is member facing Job Description: Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development,… more
- A-Line Staffing Solutions (Lake City, FL)
- …and long term care services Assist member with filing and resolving complaints and appeals Bilingual Case Manager Requirements MSW 1 year peds or LPN with 4 year ... Peds experience LPN, or MSW without clinical license If you think this Bilingual Case Manager position is a good fit for you, please reach out to me - feel free to e-mail or apply to this posting! more
- A-Line Staffing Solutions (Dallas, TX)
- …and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed Prior Authorization ... Representative Requirements 2+ years experience working in customer service/call center, preferably in a health care setting Basic experience using Microsoft Word and Excel High School Diploma or GED Attendance is mandatory for the first 90 days If you think… more
