- HCA Healthcare (Nashville, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Appeals Specialist with Parallon you can be a part of an organization ... need to succeed in our organization. We are looking for an enthusiastic Appeals Specialist to help us reach our goals. Unlock your potential! **Job Summary and… more
- HCA Healthcare (Nashville, TN)
- …local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all ... that invests in you as an Impatient Coding Denial Specialist ? At Parallon, you come first. HCA Healthcare has...We are looking for a dedicated Impatient Coding Denial Specialist like you to be a part of our… more
- Intermountain Health (Nashville, TN)
- **Job Description:** The Pre-Access Authorization Specialist II serves as a subject matter expert (SME) in the department to accurately verifying and completing ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- Army National Guard Units (Nashville, TN)
- …EXCEPTED SERVICE POSITION. This National Guard position is for a TRAFFIC MANAGEMENT SPECIALIST (TITLE 5), Position Description Number NGT5799501 and is part of the ... Chapter 115 (Pyramid on the River Chapter). Responsibilities As a TRAFFIC MANAGEMENT SPECIALIST GS-2130-09 (TITLE 5) you will support the DMC with the planning and… more
- J&J Family of Companies (Nashville, TN)
- …**Job Description:** We are searching for the best talent for Area Business Specialist to be in Nashville TN. **About Immunology** Our expertise in Innovative ... of the way. Learn more at https://www.jnj.com/innovative-medicine As the Area Business Specialist (ABS), you will: + Ensure appropriate identified new and existing… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Intermountain Health (Nashville, TN)
- **Job Description:** The Pre-Access Authorization Specialist I is responsible for accurately verifying and completing insurance eligibility, securing prior ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- CVS Health (Nashville, TN)
- …Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- Centene Corporation (Nashville, TN)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point of ... contact and liaison between assigned providers and the health plan. + Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues. + Act as department subject matter expert. +… more
- CVS Health (Franklin, TN)
- …including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing. + Ability to work in a fast paced environment, handling ... both inbound and outbound calls. + Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. + Good communication skills are essential, both internal and external. + Knowledge of Medicare… more
- Cardinal Health (Nashville, TN)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more
- Community Health Systems (Franklin, TN)
- …and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical ... and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case management software with documentation of… more