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Description

Claims Appeals Representative

Works collaboratively with Case Management (CM) Leadership, Case Managers (CM), Complex Discharge Planners (CDP) and other Resource Center (RC) staff in the CM department to support maximum reimbursement for CHS from payors. Communicates clinical reviews and refers payor questions to appropriate CM. Collaborates with Patient Financial Services, Administration, CMs, physicians and financial counselors to ensure appropriate reimbursement from third party, private and government payors, for medical services provided in acute care setting.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Covenant Medical Center and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Please note the following important details regarding this role:

+ This role is an onsite position and will report onsite daily as scheduled

+ Flexibility to work a rotating schedule, including weekends & holidays as scheduled

+ Positions specified as “on call/per diem” refer to employment consisting of shifts scheduled on an “as needed basis” to fill in for staff vacancies

Preferred Qualifications:

+ Associate Degree

+ 3 or more years of experience in managed care claims/ reimbursement setting or experience working in another other healthcare field

+ 1 or more years of experience in managed care claims / reimbursement

+ 1 or more years of experience in a healthcare environment

+ Customer service experience

+ Healthcare experience

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

**Requsition ID:** 377683

**Company:** Covenant Jobs

**Job Category:** Claims

**Job Function:** Revenue Cycle

**Job Schedule:** Per-Diem

**Job Shift:** Day

**Career Track:** Admin Support

**Department:** 8009 UTILIZ REVIEW TX CMC

**Address:** TX Lubbock 3615 19th St

**Work Location:** Covenant Medical Center

**Workplace Type:** On-site

**Pay Range:** $17.12 - $26.18

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.