- Humana (Helena, MT)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents +...Review documents + Building cases + Inventory Management + Data Entry **Use your skills to make an impact**… more
- AmeriHealth Caritas (Newark, DE)
- …position is responsible for the administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals , and the review ... medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial reasons,… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Kelly Services (Glastonbury, CT)
- …terminology to process claims accurately. + Process and adjust medical claims and appeals according to established policies and procedures. + Prepare ... **Job Title:** **Medical Claims Account Manager** **Reports To:** CFO **FLSA Status:**...(SLAs). **Essential Duties and Responsibilities** _The following duties are representative of the role. Other duties may be assigned… more
- UNC Health Care (Chapel Hill, NC)
- …**Job Responsibilities:** + Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals , response to denials, and ... payer, system or escalated account issues. + May maintain data tables for systems that support PB Claims... data tables for systems that support PB Claims operations. + Evaluate carrier and departmental information and… more
- TEKsystems (Chicago, IL)
- …insurance information, and resolve recoupment issues + Access payer websites to gather data and resolve claims + Communicate system access issues, payor trends, ... are seeking a highly skilled and detail-oriented Patient Account Representative to join our Revenue Cycle team. This role...of medical collections experience including working with denials and appeals + UB-04/hospital claims experience + EPIC… more
- Owens & Minor (Kansas City, KS)
- …The collections representative follows-up with insurance companies to resolve unpaid claims . The anticipated hourly range for this position is $10.99 - $17.70. ... customers on delinquent payments. + Reviews unpaid and underpaid claims . Resubmits or appeals as necessary. +...a strong ability to understand, interpret and develop spreadsheet data . **Other Skills** **PHYSICAL DEMANDS** This is a stationary… more
- Weill Cornell Medical College (New York, NY)
- …the practice management billing system as needed. Tracks and resolves issues on denied claims . Resubmits or appeals claims as required. Escalates more ... Title: Account Representative Location: Upper East Side Org Unit: Billing...Under direct supervision, processes payments, researches accounts and performs data entry and other related billing activities **Job Responsibilities**… more
- CVS Health (Olympia, WA)
- …Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/ Claims Research Medicaid team. Extensive claims research on ... new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with credentialing/re-credentialing and… more
- Northwell Health (New Hyde Park, NY)
- …edits and their impact on claims + Ability to analyze large datasets (eg, claims data , denial trends) to identify patterns, root causes of errors, and areas ... + Coordinates clinical documentation requests to business office to ensure timely appeals . + Develops and implements policies and procedures to facilitate billing… more
- Banner Health (AZ)
- …activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a ... CORE FUNCTIONS 1. May be assigned to process payments, adjustments, claims , correspondence, refunds, denials, financial/charity applications, and/or payment plans in… more
- University of Rochester (Rochester, NY)
- …edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims , including compiling all necessary information and ... determined by considering factors including, but not limited to, market data , education, experience, qualifications, expertise of the individual, and internal equity… more
- University of Rochester (Rochester, NY)
- …protocols in selecting for routine and non-routine letters of correspondence related to appeals on denied claims , billing and patient communications. + This ... determined by considering factors including, but not limited to, market data , education, experience, qualifications, expertise of the individual, and internal equity… more
- Intermountain Health (Juneau, AK)
- …service behavior standards + Perform other duties as assigned **Skills** + Insurance Claims + Medical Billing + Explanation of Benefits (EOB) + Translations + ... such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications),… more
- City and County of San Francisco (San Francisco, CA)
- …& DUTIES According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job class and are not ... and presents summary findings and recommendations to stakeholders by implementing data collection tools, such as Microsoft Forms. + Composes written material,… more
- MyFlorida (Tallahassee, FL)
- …(relocation benefits are not available for this position) OPS Employment Security Representative II This position will be used for multiple vacancies. OPEN ... issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through… more
- MyFlorida (Fort Lauderdale, FL)
- …(relocation benefits are not available for this position) OPS Employment Security Representative II This position will be used for multiple vacancies. OPEN ... issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through… more
- MyFlorida (Orlando, FL)
- …(relocation benefits are not available for this position) OPS Employment Security Representative II This position will be used for multiple vacancies OPEN ... The Work You Will Do: This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department of Commerce's Reemployment… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …manages the day to day duties of the Risk Management program. Processes administrative tort claims and 1151 claims , reporting data as indicated to the Tort ... situations requiring Administrative Investigation Boards. Serves as the Quality Management representative on hospital committees. Analyzes risk management data … more
- LogixHealth (Dania Beach, FL)
- …follow-up experience in professional healthcare billing + Familiarity with payer regulations, claims appeals processes, and denial reasons + Proficiency in EHR ... A/R (Accounts Receivable) reports to follow up on unpaid claims + Send out appeals on ...perform each Key Responsibility satisfactorily. The following requirements are representative of the knowledge, skills, and/or ability required to… more