- St. Luke's University Health Network (Allentown, PA)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- St. Luke's University Health Network (Allentown, PA)
- …health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and defend… more
- Penske (Reading, PA)
- …audits, including negotiating with auditors and interfacing with taxing jurisdictions. -Perfect appeals and refund claims . -The position will require the ability ... and efficiencies are met. -The ability to query, analyze data , and map detailed processes coupled with analytical skills...Requirements:** -The physical and mental demands described here are representative of those that must be met by an… more
- Owens & Minor (Harrisburg, PA)
- … representative follows-up with insurance companies to resolve unpaid claims . **ESSENTIAL DUTIES AND RESPONSIBILITIES** + Researches any overdue account balance ... customers on delinquent payments. + Reviews unpaid and underpaid claims . Resubmits or appeals as necessary. +...a strong ability to understand, interpret and develop spreadsheet data . **Other Skills** **PHYSICAL DEMANDS** This is a stationary… more
- Highmark Health (Harrisburg, PA)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… 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...(BAC), reviewing, researching, presenting, and responding to administrative plan appeals . + Processing all health, welfare, and wellness vendor… more