- Community Health Systems (Fort Smith, AR)
- **Job Summary** The Remote Medical Appeals Specialist is responsible for reviewing patient accounts denied for insurance reimbursement or paid ... Functions** + Reviews denied claims and incorrect payments, initiating the appeals process to secure appropriate reimbursement from insurance carriers. +… more
- Equitable (Charlotte, NC)
- Appeals Specialist , Disability Claims ( 25000066 ) **Primary Location** : UNITED STATES-NC-Charlotte **Other Locations** : UNITED STATES- Remote , UNITED ... your potential? Equitable is seeking an influential and dynamic Appeals Specialist to join our Disability and...Equitable provides a full range of benefits. This includes medical , dental, vision, a 401(k) plan, and paid time… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (ALD) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the… more
- Intermountain Health (West Valley City, UT)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. Fully... RN consultants in their various capacities. Fully remote position! + **Essential Functions** + Serves as the… more
- Community Health Systems (Sarasota, FL)
- **Job Summary** The Collections Specialist I is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ... or a related field preferred + 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required +… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- State of Colorado (Denver, CO)
- ECMC Enforcement Advisor (Compliance Specialist IV) - Remote /Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4887965) Apply ECMC ... Enforcement Advisor (Compliance Specialist IV) - Remote /Hybrid Salary $68,100.00 -...addition to offering rewarding, meaningful work, we offer: + Medical , Vision and Dental plans + Strong, flexible retirement… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Revenue Integrity Charge Specialist - Medical ** **Associates - Remote - FT** If you ... we care for more people in more places. This position is full time remote . **Position Highlights:** + **Quality of Life:** Where career opportunities and quality of… more
- St. Luke's University Health Network (Allentown, PA)
- …, case resolution, and impact on revenue and trending. + Coordinates RAC appeals for complex case reviews for medical necessity, including determining if ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for... reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists… more
- Community Health Systems (Fort Smith, AR)
- **Job Summary** The Remote Medical Insurance Reimbursement Specialist is responsible for processing, reviewing, and verifying reimbursement claims to ensure ... transaction codes to facilitate accurate claims processing. The Reimbursement Specialist I collaborates with internal teams to support workflow efficiency,… more
- AdventHealth (Altamonte Springs, FL)
- …**together** we are even better. **Shift** : Monday-Friday **Job Location** : Remote **The role you will contribute:** This position is responsible for investigating ... best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and...obtain further patient information to be used in the appeals process if necessary. + Provide reports, education, and… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** **Description:** Certified Coder Fully remote . May include every 5th weekend rotation **POSITION PURPOSE** Responsible for ... are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State and Private payer regulations.… more
- Avera (Wagner, SD)
- …issues and also help with patient concerns. Will assist in denial management and appeals . Day shift hours, Monday through Friday. ** Remote work is NOT ... **Position Highlights** **Starting rate of pay is $26.50 per hour.** The Billing Specialist will be responsible for the daily billing operations for designated areas… more
- ProMedica Health System (Toledo, OH)
- …documentation and coding practices, including regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance with CMS ... or other payer requests; performs appropriate follow up including appeals and corrective actions with departments and staff. 8....other duties as assigned. This position can be worked remote . Must live in 150 mile or less radius… more
- Trinity Health (Syracuse, NY)
- …are in alignment with in AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, State and Private payer ... Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis and tracking as needed.Educates clinical… more
- CVS Health (Austin, TX)
- … adjudication authority or processing expertise. + Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . + Insures all compliance requirements are satisfied and all… more
- CareFirst (Baltimore, MD)
- …and quality monitoring organizations (NCQA). + Builds and maintains high performance complex medical networks to support the needs of the market and our clients. + ... hospitalist, diabetes education, reduction of authorizations, reduction of claims appeals , etc.). Participate in internal and external committees and workgroups,… more
- Colorado State University (Fort Collins, CO)
- …assist in other billing roles as needed. At this time, the Insurance Payment Poster Specialist works a hybrid onsite/ remote schedule from 8:00 AM - 5:00 PM, ... medical insurance plan. + Work with the other Medical Billing &payment Posting Specialist to determine...provided by the insurance company for necessary claims denial appeals . + Evaluate student insurance policy eligibility by utilizing… more
- State of Colorado (Denver, CO)
- Employee Relations Specialist & ADA Program Administrator (HR Spec IV) - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4927815) Apply ... Employee Relations Specialist & ADA Program Administrator (HR Spec IV) -...relate to performance management, progressive discipline, employee grievances and appeals , and civil rights. You will also be the… more