- CareFirst (Baltimore, MD)
- …without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties ... **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for...previous experience working with government programs enrollees (Maryland Medicaid; Medical Advantage) in a healthcare payor organization. + Knowledge… 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 ... the services/treatment rendered. JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for diagnosis and procedure code assignment and… more
- 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 ... care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task… 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 ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...want you to apply! **Job Summary and Qualifications** The Appeals Specialist will be responsible for performing… more
- McLaren Health Care (Mount Pleasant, MI)
- … demonstrating accuracy/proficiency in referencing support from the medical recorddocumentation and coding guidelineswith timely and successful submissions. ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications 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
- Molina Healthcare (Bothell, WA)
- …appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- TEKsystems (Addison, TX)
- …medical biller,anesthesia Additional Skills & Qualifications - Proven experience as an Appeals Specialist or in a similar role within a healthcare setting. ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… 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
- 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 ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… 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 ... + Ability to work independently or with a team as necessary. + Medical front-office, medical case management, and/or medical social work experience a plus. +… more
- State of Indiana (Indianapolis, IN)
- Appeals & Eligibility Specialist Date Posted: Jan 9, 2026 Requisition ID: 466621 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... a comprehensive benefit package for full-time employees which includes: + Three (3) medical plan options (including RX coverage) as well as vision and dental plans… more
- Nuvance Health (Danbury, CT)
- …with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role ... payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review,...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Northwell Health (Melville, NY)
- …the third party payer. + Prepares and defends level of care and medical necessity for assigned case. + Collaborates with physician advisor, payor representative and ... + Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- University of Washington (Seattle, WA)
- …reviewing initial clinical denials to determine next steps. Additionally, they conduct appeals as appropriate by reviewing medical necessity, and/or reconciling ... communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity reviews, based on denial root… more
- Community Health Systems (Franklin, TN)
- …of experience in medical billing, revenue cycle, or claims denials and appeals processing required + Prior experience with revenue cycle processes in a hospital ... **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and...Skills and Abilities** + Strong knowledge of payer guidelines, medical billing practices, and appeal processes. + Proficiency in… 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 ... underpayments to ensure accurate reimbursement. This role involves reviewing medical documentation, interpreting payer policies, and preparing detailed appeal… more
- Houston Methodist (Houston, TX)
- …items that result in resolution. Engages the coding follow up team for any medical necessity or coding related appeals . + Assures accounts are completed and ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review...National Coverage Determination (NCD) + Competence in writing clinical appeals for medical necessity compliance or level… more
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