- St. Luke's University Health Network (Allentown, PA)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials and ... + Must have computer skills and dexterity required for data entry and retrieval of patient information. Must be...**Job Duties** + Review and analyze denied or underpaid claims to determine appeal opportunities. + Prepare and submit… more
- Mendocino County Sheriff's Office (Ukiah, CA)
- …Must obtain accreditation by the California Department of Veterans Affairs as a Claims Representative in accordance with Title 38 Code of Federal Regulations ... such as military, medical, and legal records. + Prepares, submits, and monitors claims and appeals through appropriate federal, state, and local channels,… more
- TEKsystems (Farmington, CT)
- …submitted claims that remain unprocessed + Prepare and submit reconsiderations and appeals within filing limits + Perform detailed data analysis and research ... Insurance Follow‑Up Representative (Hybrid) Shift: 7:30 am - 4:00 pm...hospital billing operations. This role focuses on resolving medical claims denials, conducting detailed follow-up with insurance payors, and… more
- SSM Health (Madison, WI)
- …and payment rules. Bills claims appropriately. + Follows up on denied claims by performing appeals and denial recovery procedures. Works denied claim lines ... or more of the following: processing insurance payments, following up on denied claims , and resolving credit balances. May work in multiple functional areas. **Job… more
- Owens & Minor (Springfield, IL)
- … representative follows-up with insurance companies to resolve unpaid claims . **ESSENTIAL DUTIES AND RESPONSIBILITIES** + Researches any overdue account balance ... 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
- State of Colorado (Denver, CO)
- Health Care Representative Center Call Agent Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5156102) Apply Health Care Representative ... a customer service role related to health insurance, health care operations, insurance claims and billing, collections, or a field related to the work assignment… more
- Banner Health (WY)
- …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
- Robert Half Accountemps (Palo Alto, CA)
- …underpayments; research contracts, guidelines and resolve payment with payer. Perform appeals with payer. Performs bad debt request transfers as applicable. Performs ... and resolves edits; Reviews and resolves electronic acknowledgement payer rejections/denials; Rebills claims based on requests from Follow Up reps due to denials… more
- State of Massachusetts (Boston, MA)
- …work, available for work and looking for a job. The Job Service Representative I performs customer service and issue resolution by assisting employers or claimants ... determinations in accordance with MGL Chapter 151A, 430 CMR, the Job Service Representative 's Handbook, and established Revenue Procedures as well as the Code of… more
- State of Colorado (Pueblo, CO)
- …Coloradans. What we do: Retail Operations provides the sale of Lottery products, claims processing, redemption of prizes, and customer service at the Pueblo, Denver, ... Grand Junction, and Ft. Collins Claims Counters, including providing customer service support to retailers,...from many levels within the organization and community. + Data Entry including: entering information into a program or… more
- University of Rochester (Albany, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. + 10%… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... include but are not limited to researching, correcting, resubmitting claims , submitting appeals and taking timely and...and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative … more
- State of Colorado (Denver, CO)
- …dose cassettes). + Issues credits back to clients. + Process Medicare Part D claims . + Completes associated paperwork and computer data entry. Package and Fill ... of inventory for (near) outdated medication for removal and replacement, data entry, ordering and restocking pharmaceuticals and supplies, pre-packaging and labeling… more
- Amentum (Washington, DC)
- …Fund ("VCF") was created to provide compensation for any individual or personal representative of a deceased individual who suffered physical harm or was killed as ... claim review team work, with a particular emphasis on claim and data management, claim assessment, knowledge management and training coordination. Working closely… more
- PeaceHealth (Vancouver, WA)
- …Responsible for all areas of billing and account follow-up including claims submission, account follow-up with insurance payors, and resolution of reimbursement ... **Essential Functions** + Resolves insurance claim rejections/denials, and non-payment of claims by payors. + Identifies trends in billing and follow-up, in… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … data across multiple domains, including utilization management, prior authorization, claims , denials, and appeals . Their work goes beyond extraction; it ... with internal teams such as Network and Pharmacy, ensuring data is pulled using the most representative ...degree. * Knowledge of managed care and health care claims preferred. * Experience with Databricks preferred. Compensation and… more
- State of Colorado (Denver, CO)
- …contract compliance, and evaluating performance. + Review and approve/deny payment of claims for grant reimbursement of work and materials and evaluate overall ... both written and oral + Understanding of traffic safety data , trends, and analysis + Ability to influence, persuade...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- Iowa Department of Administrative Services (Cedar Rapids, IA)
- …contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit ... contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit… more
- Highmark Health (Montpelier, VT)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
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