- 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 +...MedHOK experience strongly preferred + Previous experience processing medical claims **Required Work Schedule** **This is a remote role… more
- Commonwealth of Pennsylvania (PA)
- …+ Four years of experience in the determination of unemployment compensation claims , including adjustments, overpayments, and appeals supplemented by 6 college ... of full-time experience do you possess in the determination of unemployment compensation claims , including adjustments, overpayments, and appeals ? + 4 years or… 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
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… 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
- Humana (Baton Rouge, LA)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- State of Minnesota (St. Paul, MN)
- **Working Title** **: Veterans Claims Representative ** **Job Class: Veterans Claims Representative ** **Agency: Minnesota Department of Veterans Affairs** ... advocate for veterans and their dependents by preparing and monitoring claims and appeals before the US Department of Veterans Affairs, Decision Review Officers… more
- Texas Veterans Commission (Fort Worth, 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
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Patient Account ... Representative (PAR)** is expected to perform specific billing processes,...taking necessary actions to obtain account resolution + Submits appeals , as appropriate, for all non-clinical denials + Monitors… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Insurance ... Patient Account Representative ** is an extension of a client's business office...from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up +… 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
- US Tech Solutions (Myrtle Beach, SC)
- …equivalent. + Required Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work ... Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims … more
- Houston Methodist (Houston, TX)
- …functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity or ... At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for… more
- Independent Health (Buffalo, NY)
- …and 5pm** **Monday through Friday** . **Overview** The Provider Relations Representative will be responsible for assisting our provider constituents and providing ... exceptional customer service. The Provider Relations Representative will answer incoming calls from health care providers including physician offices, ancillary… 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 ... a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials. + Works… more
- Independent Health (Buffalo, NY)
- …culture that fosters growth, innovation and collaboration. **Overview** The Servicing Representative is a customer service professional who displays confidence, a ... listening towards all Pharmacy Benefit Dimensions (PBD) customers. The Servicing Representative functions as an advocate for all customers and resolves all… more
- Primary Health Care (Des Moines, IA)
- …file claims and research and resolve denials. The billing representative is responsible for completing daily and monthly reporting requirements. Ensures ... in Ames, Des Moines, & Marshalltown. As a Billing Representative - Self Pay you will be responsible for...and accurate submission and follow-up of medical or dental claims on behalf of Primary Health Care, Inc. Routinely… more
- US Physical Therapy (Franklin, TN)
- …of insurance interactions and patient billing information while preparing and submitting appeals for denied claims . 4. Provide excellent customer service to ... and one another. **Job Description** **Job Summary:** The Accounts Receivable Representative for our Physical Therapy Company is responsible for managing and… more
- Cardinal Health (Columbia, SC)
- …as assigned in the appropriate system. + Manages and resolves complex insurance claims , including appeals and denials, to ensure timely and accurate ... done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as… more
- TEKsystems (Chicago, IL)
- …Qualifications + 3+ years of medical collections experience including working with denials and appeals + UB-04/hospital claims experience + EPIC + Must sit in ... are seeking a highly skilled and detail-oriented Patient Account Representative to join our Revenue Cycle team. This role...+ Access payer websites to gather data and resolve claims + Communicate system access issues, payor trends, and… more
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