- Stanford Health Care (Palo Alto, CA)
- …of America) **This is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in ... applied knowledge, skills and abilities and professional behaviors. Clinical Government Audit Analyst and Appeal Specialist II is the full proficiency or… more
- UCLA Health (Los Angeles, CA)
- …support UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory ... relevant systems, distributing requests to necessary teams + Monitor audit response and appeal statuses, tracking cases...necessary teams + Monitor audit response and appeal statuses, tracking cases and maintaining updated records in… more
- McLaren Health Care (Mount Pleasant, MI)
- …resolution. 6. Provides support in response, tracking and completion of all payer audit /denial/ appeal activity to ensure that timelines in the process are met, ... **Position Summary:** Responsible for timely and accurate processing, follow-up, and appeal of audits and denial activity received from payers and/or auditors .… more
- Beth Israel Lahey Health (Newburyport, MA)
- …direction of the Director of Health Information Management, the Health Information Management Audit Specialist handles various audit requests for the release ... all the logging and tracking of requests and the audit process from initiation through mailing, in collaboration with...and complete submission of required documentation to support the appeal process. . Ensures that all patient medical information… more
- State of Colorado (Denver, CO)
- Child Welfare Licensing Social Services Specialist IV Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5133050) Apply Child Welfare Licensing ... Social Services Specialist IV Salary $71,544.00 - $93,024.00 Annually Location Denver...monitoring of the 24-hour child care facilities and to audit and investigate reports/allegations involving licensing violations, facility or… more
- St. Luke's University Health Network (Allentown, PA)
- …representatives in defense of coding appeals, as needed. + Maintain necessary audit / appeal activity documents including Excel spreadsheets, EPIC Payor Audit ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all… more
- Iowa Department of Administrative Services (Des Moines, IA)
- SRF Project Compliance Specialist Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/5144307) Apply SRF Project Compliance Specialist Salary ... can be released to the SRF borrower. The compliance specialist serves as the first point of contact for...guidance. The position may also be responsible for preparing audit findings and enforcement actions, participating in legal or… more
- Guthrie (Sayre, PA)
- …Accounts Receivable Management department is seeking a skilled and motivated Insurance Specialist II to lead and support complex billing processes, mentor staff, and ... a team that feels like home. Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as a group leader by participating in staffing… more
- Guthrie (Towanda, PA)
- Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as a group leader by participating in staffing and employment issues. ... Serves as a resource specialist within the department. Trains Insurance Billing Specialists I...trends and provides appropriate follow‐up for claims that require correction/ appeal . 3. Demonstrates skills and proficiency in analyzing complex… more
- RVO Health (Charlotte, NC)
- **AT A GLANCE** We are seeking a precision-focused Senior Procurement Specialist to execute sourcing operations under strategic leadership. As procurement's ... + Keep contract repositories, approval records, and risk assessments, audit -ready + Vendor Management: + Maintain 100% policy-compliant procurement workflows.… more
- University of Southern California (Alhambra, CA)
- …compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all coding-related 'claims denials' ... inappropriately paid by the payer/external auditors, and determining the need for appeal . Performs all 1st and 2nd level coding-related denial appeals. All tasks… more
- Commonwealth Care Alliance (Boston, MA)
- …on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit , compliance, and provider engagement initiatives. This role also provides ... CMS payment methodologies (eg, DRG, APC, RBRVS). + Support provider appeal reviews and internal payment integrity investigations by providing reimbursement… more
- MyFlorida (Tallahassee, FL)
- …and/or require training for deficiencies, as appropriate. Provide training as result of audit issues and testify at appeal hearings regarding training concerns. ... FNW PROGRAM SPECIALIST IV-DACS - 42005678 Date: Oct 23, 2025...Agency: Agriculture and Consumer Services Working Title: FNW PROGRAM SPECIALIST IV-DACS - 42005678 Pay Plan: Career Service Position… more
- Henry Ford Health System (Troy, MI)
- … Specialist is a support role crucial in the centralized Payor Audit department for Medical Record request submissions, appeal tracking, and resolution ... Epic preferred. Additional Information + Organization: Corporate Services + Department: Payor Audit + Shift: Day Job + Union Code: Not Applicable Additional Details… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** The PFS Denial Specialist I role is vital to ensure that hospital denied accounts are thoroughly ... reviewed for any opportunity to correct, refile and or appeal claims for re-processing and reimbursement. The role also...and serves on committees as requested. 14. Maintains appropriate audit results or achieves exemplary audit results.… more
- Houston Methodist (Houston, TX)
- …any claim issues or concern that may require clinical review during the pre-bill, audit , or appeal process. + Secures reimbursement for hospital services by ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and… more
- Hospice of Michigan (Southfield, MI)
- …(CERT), Recovery Audit Contractor (RAC) etc., requests and participates in appeal processes. + Participates in the development and annual revision of Quality ... Assessment and Improvement Plans and Program Evaluation. + Participates in analyzing, developing, coordinating and implementing plans of correction for noted deficiencies. + Makes recommendations to the education committee for mandatory education related to… more
- State of Colorado (Broomfield County, CO)
- …to ensure integrity and provide excellent customer service. Position will audit HR processes to ensure they correspond to accessibility standards. Position ... Excel, Access, Word, and PowerPoint, in order to manage applicant information. + Audit selection paperwork to ensure that all the hiring processes have been followed… more
- State of Colorado (Denver, CO)
- …review and adjust as necessary process on documentation and reconciliations; respond to audit requests as received by the Office of the State Auditor or other ... agency managers and employees on department system(s) and processes, to correct audit deficiencies, and other issues that arise; ensure critical procedures are… more
- State of Colorado (Pueblo, CO)
- …nursing directives using effective communication. + Collaborates with the Clinical Safety Specialist (CSS) in the event of safety and security needs, to ensure ... performance issues. + The Relief Pool and Ambulatory Clinic Manager completes the QAPI audit to identify any deficiencies. + Creates a plan of action to correct the… more
