- Covenant Health (Lubbock, TX)
- **Description** ** Claims Appeals Representative ** **Works collaboratively with Case Management (CM) Leadership, Case Managers (CM), Complex Discharge ... 3 or more years of experience in managed care claims / reimbursement setting or experience working in another other...1 or more years of experience in managed care claims / reimbursement + 1 or more years of… 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 coding ... by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with...preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue… more
- Texas Veterans Commission (Midland, 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
- UCLA Health (Los Angeles, CA)
- …medical terminology, and confidentiality compliance + Proven ability to resolve complex claims , process adjustments, and manage appeals effectively + Proficiency ... Description UCLA Health is seeking a Senior Cross-Functional Collections Representative to support Patient Business Services by managing a diverse portfolio of… more
- University of Rochester (Rochester, NY)
- …composes edits and obtains signatures for non-routine letters of correspondence related to appeals on denied claims . + This includes compiling all necessary ... overbooking and rearranging of surgeons Operating Room schedules based on case complexity and medical urgency. + Authorizes rescheduling when cancellations occur… more
- University of Rochester (Rochester, NY)
- …edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims , including compiling all necessary information and ... overbooking and rearranging of surgeon's Operating Room schedules based on case complexity and medical urgency. + Authorizes rescheduling when cancellations occur… more
- Cardinal Health (Santa Fe, NM)
- …needs of the patient and/or program + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance ... + Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- Independent Health (Buffalo, NY)
- …of internal and external service groups. + Coordinate with external agencies to prepare case files when needed for external appeals . + Thorough and accurate ... completion of log worksheet to maintain consistency in logging complaints/ appeals . Maintain and monitor outstanding case logs to plan and prioritize workload.… more
- Independent Health (Buffalo, NY)
- …internal and external service groups. + Coordinate with external agencies to prepare case files when needed for external appeals . Departmental Support + Assist ... and consistent review and investigation of provider and/or member complaints and/or appeals . The Contractual Reviewer-Senior will be required to rely on their… more
- Fallon Health (Worcester, MA)
- …and appeals , which includes, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from ... LinkedIn. **Brief summary of purpose:** The Fallon Health (FH) Appeals and Grievance process is an essential function to...FH members and FH with their complaints regarding denied claims , referrals, membership, and benefit issues as well as… more
- State of Colorado (Denver, CO)
- …employment laws; responding to grievances, equal Employment Opportunity Commission (EEOC) claims , appeals , charges of discrimination; settlement advice; benefits ... laws; progressive discipline; records management; recruitment; responding to grievances, appeals , charges of discrimination; reorganization issues; retention; selection and… more
- Wounded Warrior Project (Phoenix, AZ)
- …military service. The NSO guides and manages the preparation and processing of all claims and subsequent appeals through the Department of Defense (DoD) and ... the DoD and DVA. + Prepare briefs for pending appeals located at the local VA Regional Office level....laws, regulations, and benefits. + Maintain and update WWP case management electronic tracking systems. + Develop community support… more
- Iowa Department of Administrative Services (Spencer, IA)
- …public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit ... public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit ... public contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit… more
- Fresenius Medical Center (Dallas, TX)
- …and/or liability oriented questions or issues to multiple divisions of FME. Litigates claims . + Develops and directs overall case management and strategy from ... internal FME business clients in negotiations, pre-suit matters, litigation and appeals . Provides litigation support on the company's behalf and coordinates… more
- Phoenix House (Wainscott, NY)
- …for patients receiving behavioral health services. The Manager will monitor claims and approvals to ensure uninterrupted service provision. This position is ... discharge information to insurance companies . Initiate and resolve appeals . Work with the clinical and nursing teams...information needed for reviews . Participate in weekly clinical case conferences . Utilize OASAS LOCADTR (Level of Care… more
- LifePoint Health (Richlands, VA)
- …and the RAC reviewers. Coordinates all files, response letters and files appropriate appeals , necessary in collaboration with Case Management and the physicians. ... RHC State Surveyor: Policies; Staff Licensure and Credentials. * Coordinates Risk case review, in conjunction with the Operations Team, when applicable. * Notifies… more
- Avera (Mitchell, SD)
- …government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage ... complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff. + Work with… more
- Guardian Life (Bethlehem, PA)
- …and key resource for day-to-day tier 3 escalations related to eligibility, enrollment, and claims . This includes but is not limited to: + Overseeing the Field ... Representative billing process and collaborating with internal stakeholders and...escalation contact to resolve plans/member escalations by leveraging the case management system. + Performing as the secretary for… more