- Stanford Health Care (Palo Alto, CA)
- …analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist ...Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments;… more
- HCA Healthcare (Nashville, TN)
- …TX, UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Specialist Medicare ? At Parallon, you come first. HCA ... and you have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Specialist Medicare like you to be a part of our team.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write...trends; including denials that have been escalated to the Medicare Administrative Law Judge (ALJ). + Represent DFCI at… more
- Cognizant (Atlanta, GA)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare , Medicaid,...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... line of business within Martin's Point Health Care, including Medicare Advantage, US Family Health Plan (USFHP). + Demonstrates...projects. + Independently partners with Medical Directors and other clinical support staff on appeals requiring … more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and...facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews… more
- Insight Global (Pleasanton, CA)
- Job Description Insight Global is seeking a Medicare Billing Specialist to join their clients team. The Medicare Billing Specialist is responsible for ... the accurate preparation, submission, and reconciliation of Medicare claims for outpatient mental health services. This role ensures compliance with Medicare … more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a ... for licensure by examination or reciprocity is required. The Clinical Pharmacy Specialist provides clinical ...in managing member care through the prior authorization and appeals process for medications. These services will be provided… more
- HCA Healthcare (Brentwood, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- US Tech Solutions (RI)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract**...internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical … more
- Robert Half Accountemps (Duarte, CA)
- Description We are looking for an experienced Medical Biller/Collections Specialist to join our team in Duarte, California. The Medical Biller/Collections ... Specialist will play a vital role in managing the...claims are processed accurately and efficiently while adhering to Medicare , Medi-Cal, and other insurance guidelines. This is an… more
- State of Colorado (Grand Junction, CO)
- Social Worker / Counselor I (Behavioral Health Specialist ) - Grand Mesa Youth Services Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5109843) ... Apply Social Worker / Counselor I (Behavioral Health Specialist ) - Grand Mesa Youth Services Salary $2,614.62 Biweekly Location Grand Junction, CO Job Type Full… more
- CaroMont Health (Gastonia, NC)
- …record for clinical denials. Composes a detailed summary of care and sends appeals to MCO, Medicare , or RAC for reversal of original determination. May serve ... appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process....appeals as part of denial process. The UR Specialist will be cross trained to work for the… more
- State of Colorado (Denver, CO)
- …Management & Outcomes (PMO) Residential Specialist IV Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115383) Apply Performance Management ... & Outcomes (PMO) Residential Specialist IV Salary $71,544.00 - $91,200.00 Annually Location Denver Metro, CO Job Type Full Time Job Number IHA 07248 10/17/2025… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the… more
- Robert Half Accountemps (Fort Worth, TX)
- …No clinical license required; however, experience working alongside RNs/LVNs or clinical appeals teams is beneficial. Future Growth As processes stabilize, ... Description We're seeking an experienced Infusion Billing and Denials Specialist to join a growing healthcare organization. This role will play a key part in… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …denied claims + On rotating schedule, collect billing documents from various hospital and/or clinical locations + Print and mail Ceequence appeals saved on MPIP ... **42737BR** **Extended Job Title:** Medical Billing Specialist **Org Level 1:** Texas Tech Unv Hlth...of GE Centricity, SharePoint and Cerner + Knowledge of Medicare , Sate Medicaid and Commercial insurance product guideline billing… more
- City and County of San Francisco (San Francisco, CA)
- …meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider ... + Possess a valid third-party billable provider certification (such as Medicare , Medi-Cal, and/or private insurance) OR have submitted a completed billable… more
