- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity to ... culture and make an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something you would be interested in, and you meet… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Robert Half Accountemps (Palo Alto, CA)
- Description We are seeking a Patient Account Representative to join a fast-paced and collaborative Patient Financial Services (PFS) team. The Patient Account ... Representative is responsible for accurate and timely billing, collections,...or phone communication. + Investigate and resolve underpayments; file appeals when necessary. + Review and resolve claim denials… more
- Elevance Health (Walnut Creek, CA)
- **Hearing Representative ** **Virtual** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... unless an accommodation is granted as required by law. The **Hearing Representative ** is responsible for representing clients at legal hearings before the Workers'… more
- CVS Health (Sacramento, CA)
- …all with heart, each and every day. **Position Summary** Our Customer Service Representative is the face of Aetna/Mercy Care and impacts members' service experience ... and responsibilities in accordance with contract. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. + Performs… more
- CVS Health (Sacramento, CA)
- …heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service ... and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents expectations are met or… more
- UCLA Health (Los Angeles, CA)
- Description UCLA Health is seeking a Senior Cross-Functional Collections Representative to support Patient Business Services by managing a diverse portfolio of ... + Proven ability to resolve complex claims, process adjustments, and manage appeals effectively + Proficiency in Epic or similar billing systems, with strong… more
- Cardinal Health (Sacramento, CA)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …position is responsible for pulling medical records to submit with claims and appeals as required by payors. Responsible to validate and accurately complete the ... claims identified with potential new payor plan coverage added to the patient's account. Assists with other related duties as assigned. SKILLS REQUIRED: - Excellent verbal communication and active listening. Effective verbal communication is one of the most… more