- Optum (San Juan, PR)
- … should be reviewed/handled, or routed to other departments Classify and set up the case in the appeals system Ensure accurate data entry based on research ... in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. This position will communicate with appropriate parties… more
- CAPPS (Midland, TX)
- …rulings, and state law in the adjudication process. *Prepares and files claims and appeals with supporting evidence for successful adjudication. *Advises ... assisting veterans and eligible persons with the Department of Veterans Affairs claims process. Work involves collaboration with external partners to include the… more
- Heluna Health (Los Angeles, CA)
- …and signed forms needed for disability, age-based, and retirement applications and appeals for SSI, SSDI, and CAPI. Safely and securely manage sensitive personal ... applications that result in benefits awards. Act as the Authorized Representative for clients applying for SSA benefits. Processes benefit survivors' applications… more
- City of Philadelphia (Philadelphia, PA)
- …Rights Unit, Tort Litigation Unit, Code Enforcement Unit, Labor & Employment Unit and Appeals Unit. The Civil Rights Unit represents the City of Philadelphia and its ... its progeny, and the immunities and exceptions provided under the Pennsylvania Tort Claims Act. This position involves providing mentorship and guidance to a team of… more
- Covenant Health (Lubbock, TX)
- **Description** ** Claims Appeals Representative ** **Works collaboratively with Case Management (CM) Leadership, Case Managers (CM), Complex Discharge ... 3 or more years of experience in managed care claims / reimbursement setting or experience working in another other...1 or more years of experience in managed care claims / reimbursement + 1 or more years of… 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 ... by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with...preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue… more
- Texas Veterans Commission (Midland, TX)
- …rulings, and state law in the adjudication process. . Prepares and files claims and appeals with supporting evidence for successful adjudication. . Advises ... Financial Operations* **Organization:** **TEXAS VETERANS COMMISSION* **Title:** *TVC - Claims Benefit Advisor (Veterans Services Representative I)* **Location:**… more
- UCLA Health (Los Angeles, CA)
- …medical terminology, and confidentiality compliance + Proven ability to resolve complex claims , process adjustments, and manage appeals effectively + Proficiency ... Description UCLA Health is seeking a Senior Cross-Functional Collections Representative to support Patient Business Services by managing a diverse portfolio of… more
- Cardinal Health (Santa Fe, NM)
- …needs of the patient and/or program + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance ... + Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- University of Rochester (Rochester, NY)
- …composes edits and obtains signatures for non-routine letters of correspondence related to appeals on denied claims . + This includes compiling all necessary ... overbooking and rearranging of surgeons Operating Room schedules based on case complexity and medical urgency. + Authorizes rescheduling when cancellations occur… more
- Independent Health (Buffalo, NY)
- …of internal and external service groups. + Coordinate with external agencies to prepare case files when needed for external appeals . + Thorough and accurate ... completion of log worksheet to maintain consistency in logging complaints/ appeals . Maintain and monitor outstanding case logs to plan and prioritize workload.… more
- State of Colorado (Denver, CO)
- …parties the option of alternative dispute resolution and either refer the case appropriately or conduct informal settlement discussions. Duties include, but are not ... information, data, and affidavits from parties, compiling and organizing case files, preserving evidence, examining documentation, analyzing evidence, conducting… more
- Wounded Warrior Project (Phoenix, AZ)
- …military service. The NSO guides and manages the preparation and processing of all claims and subsequent appeals through the Department of Defense (DoD) and ... the DoD and DVA. + Prepare briefs for pending appeals located at the local VA Regional Office level....laws, regulations, and benefits. + Maintain and update WWP case management electronic tracking systems. + Develop community support… more
- Iowa Department of Administrative Services (Spencer, IA)
- …public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit ... public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit… more
- Immigration and Customs Enforcement (Washington, DC)
- …the United States. Pursuant to statute, OPLA serves as the exclusive representative of DHS in removal proceedings before the Executive Office for Immigration ... law enforcement authorities, legal liability under the Federal Tort Claims Act and Bivens v. Six Unknown Named Agents...Employment Opportunity Commission, and the Civilian Board of contract Appeals . OPLA attorneys support DOJ in the prosecution of… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit ... public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit… more
- Fresenius Medical Center (Dallas, TX)
- …and/or liability oriented questions or issues to multiple divisions of FME. Litigates claims . + Develops and directs overall case management and strategy from ... internal FME business clients in negotiations, pre-suit matters, litigation and appeals . Provides litigation support on the company's behalf and coordinates… more
- State of Colorado (Denver, CO)
- …or options for those uninsured. + Actively listen and interpret the member's case while eliciting relevant statements to advise or instruct the member in accordance ... role related to health insurance, health care operations, insurance claims and billing, collections, or a field related to...the official appeal form signed by you or your representative . This form must be completed and delivered to… more
- Avera (Mitchell, SD)
- …government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage ... complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff. + Work with… more
- Guardian Life (Bethlehem, PA)
- …and key resource for day-to-day tier 3 escalations related to eligibility, enrollment, and claims . This includes but is not limited to: + Overseeing the Field ... Representative billing process and collaborating with internal stakeholders and...escalation contact to resolve plans/member escalations by leveraging the case management system. + Performing as the secretary for… more
