- 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
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Stryker (Nashville, TN)
- **What You'll Do:** As our **Reimbursement and Market Access Specialist ,** you'll play a key role in ensuring patient access to our innovative IVS products by ... processes-ensuring successful navigation of the billing, prior authorization, and appeals process. **Key Responsibilities:** + Respond to day-to-day reimbursement… 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
- HCA Healthcare (Nashville, TN)
- …for benefits may vary by location._** We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide all patients with ... apply! **Job Summary and Qualifications** Seeking a Clinical Denials Coding Review Specialist , who is responsible for applying correct coding guidelines and payor… 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
- 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
- Elevance Health (Nashville, TN)
- …TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). ... as a Registered Health Information Technician, CCS as a Certified Coding Specialist , CIC as a Certified Inpatient Coder, or Certified Clinical Documentation … more
- Molina Healthcare (Bowling Green, KY)
- …claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances. * Coordinates with Corporate and Business Development ... Provides training and guidance as needed to the Contract Managers and Contract Specialist (s). * Helps develop and utilize standardized contract templates and Pay for… 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