- BJC HealthCare (St. Louis, MO)
- …work experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both ... Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level of… more
- HCA Healthcare (Brentwood, TN)
- …**_Note: Eligibility for benefits may vary by location._** We are seeking an Appeals Specialist for our team to ensure that we continue to ... do. We want you to apply! **Job Summary and Qualifications** The Appeals Specialist will be responsible for performing end-to-end tasks for technical appeals… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related… more
- TEKsystems (Addison, TX)
- …terminology,medical biller,anesthesia Additional Skills & Qualifications - Proven experience as an Appeals Specialist or in a similar role within a healthcare ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… 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
- 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
- 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
- State of Indiana (Indianapolis, IN)
- Appeals & Eligibility Specialist Date Posted: Oct 16, 2025 Requisition ID: 466621 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... career with the State of Indiana by joining one of the largest employers in the state, offering a range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance.… 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
- 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
- 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 PRI's (Patient Review Instrument), as needed. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties 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
- Molina Healthcare (Omaha, NE)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals … more
- Molina Healthcare (Doral, FL)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Sanford Health (SD)
- …clinical documentation, and interpreting medical policies. The As a lead position, lead appeals and denial specialist this role will additional support the leads ... remote **Job Summary** Responsible for performing advanced level work related to appeals and denials by conducting a comprehensive review of clinical documentation,… more
- The County of Los Angeles (Los Angeles, CA)
- …Accountant I Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services ... Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services Assistant I Financial… more
- The County of Los Angeles (Los Angeles, CA)
- …Accountant I Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services ... Financial Specialist I Human Resources Trainee Intermediate Board Specialist Management Assistant Operation Assistant Personnel Assistant Senior Board … more
- University of Washington (Seattle, WA)
- …Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE + 100% Remote ... + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services in accordance with… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This ... all follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for clinical appeals as needed. + Files… more
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