- TEKsystems (Englewood, 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...claims and payer denial codes, plus hands‑on complex appeals workflows + EMR/EHR experience (ideally Epic and Athena;… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the ... full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and… more
- Nuvance Health (Danbury, CT)
- …payer practices, successfully challenging payers as they prevent obstacles and deny claims and escalating any egregious payer behaviors to internal leadership for ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the...and are evaluated without regard to mental or physical disability , race, color, religion, gender, national origin, age, genetic… 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 ... **Job Duties** + Review and analyze denied or underpaid claims to determine appeal opportunities. + Prepare and submit...staff and coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed… more
- Billings Clinic (Billings, MT)
- …Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Claims Specialist I/Government (Full-time) ... claims from government and third-party payers. The Claims Specialist is responsible for preparing and...of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from… more
- MetLife (Aurora, IL)
- …meeting all key performance indicators * Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and ... if additional information is needed to make a reasonable and logical claims determination based off the information available * Collaborates with both external… more
- Swedish Health Services (Seattle, WA)
- … to government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as necessary and resolve aged ... **Description** Follow up on insurance denials and aged claims , submit claims to secondary payers, and ensure accurate billing information is submitted. Answer… more
- Geisinger (Danville, PA)
- …for the yearly opportunity analysis. + Reviews and responds to claim edit appeals and rational requests. + Coordinates, supports, and resolves vendor needs both ... identified. + Leads internal development, testing, maintenance, and expansion of internal claims edits. + Leads the development of the ClaimsXten Policy Management… more
- Stony Brook University (East Setauket, NY)
- …will support day-to-day business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. ... Revenue Specialist **Position Summary** At Stony Brook Medicine, a...claims , improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection… more
- HSBC (Chicago, IL)
- …presenting complex information to various committees, developing strategic responses, and overseeing claims and appeals processes. Your expertise in ERISA and ... Employment ERISA and Employee Benefits Legal Specialist Brand: HSBC Area of Interest: Legal Location:...Present relevant items to the Benefits Administrative Committee and Claims and Appeals Subcommittee + Develop strategies… more
- Mount Sinai Health System (New York, NY)
- …in analysis and problem resolution to ensure accurate and timely payment of claims and collection. The Specialist works directly with the Department ... **Job Description** The Procedural Billing Specialist I is responsible for multiple components of...Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and… more
- UNC Health Care (Goldsboro, NC)
- **Description** Summary: The Government-Non-government Specialist is responsible for reviewing, submitting and resolving assigned insurance accounts to an ... all assigned government and nongovernment accounts and denials for complex financial appeals , with a goal of bringing the accounts to an appropriate financial… more
- Globus Medical, Inc. (Collegeville, PA)
- …customers from the initial processing of received documentation through prior authorization, appeals support, detailed claims review, and hotline support. The ... management. **Position Summary** **:** Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support to… more
- SERV Behavioral Health System (Hamilton, NJ)
- …Receivable Specialist will be responsible for billing and submitting claims and handling escalated billing and collection issues. The Senior Accounts receivable ... specialist serves as a subject matter expert in complex...within the standard billing cycle timeframe. + Identifies corrected claims and process all claim appeals . +… more
- Fairview Health Services (St. Paul, MN)
- …critical research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a… more
- Henry Ford Health System (Detroit, MI)
- …medication access barriers and provide effective solutions to resolve any issues. * Claims Management and Appeals : Support audits by reviewing billing and ... reimbursement activities, monitor appeals and denied claims and support Hub...to race, color, creed, religion, age, sex, national origin, disability , veteran status, size, height, weight, marital status, family… more
- State of Colorado (Denver, CO)
- Service Compliance Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5177735) Apply Service Compliance Specialist Salary ... for overtime compensation. Department Contact Information Sarah Roman, Talent Acquisition Specialist ~ ###@state.co.us How To Apply Please submit an online… more
- Trinity Health (Fort Wayne, IN)
- …Type:** Full time **Shift:** **Description:** The Specialty Pharmacy Revenue Cycle Specialist is responsible for performing the appropriate processes to obtain and ... to benefits investigation, prior authorization request and submission, overturning appeals , and enrolling patient in financial assistance programs. Manages the… more
- The Cigna Group (Bloomfield, CT)
- As a Financial Assistance Specialist , you will help patients access the financial resources they need by coordinating copay and foundation assistance programs, ... issues. You will play a key role in ensuring accurate claims processing, maintaining compliant documentation, and delivering a positive, solution‑focused experience… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization ... and related health plan functions such as member services, claims , and the referral process. As well as functions...programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level… more