- Banner Health (GA)
- …daily rounding on team members to ensure quality reviews of payer denials and/or appeals . Accurately and thoroughly completes documentation required for ... clinical expertise for team members and physicians for problem-solving on various denials and/or appeals related patient services, processes, and specific denial… more
- Molina Healthcare (GA)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist. This position is remote... appeals and denials . * Customer service experience. * Strong organizational and… more
- Molina Healthcare (Atlanta, GA)
- …subrogation and eligibility criteria. + Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Molina Healthcare is hiring for an Appeals & Grievance Specialist. This role is 100%... appeals and denials . + Customer service experience. + Strong organizational and… more
- Molina Healthcare (Macon, GA)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers... appeals and denials . + Strong verbal and written communication skills To… more
- Molina Healthcare (Columbus, GA)
- …Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Datavant (Atlanta, GA)
- …healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim denials across the entire revenue cycle to ensure optimal reimbursement and ... between coding, billing, utilization review, case management, and payer relations to reduce denials and improve revenue leakage. **You will:** + Monitor and manage … more
- Cardinal Health (Atlanta, GA)
- …in 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...changes that may need to be made. + Processes denials & rejections for re-submission (billing) in accordance with… more
- Molina Healthcare (Augusta, GA)
- …by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal into information system and prepares documentation ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Cognizant (Atlanta, GA)
- …advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process includes ... analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member of the Cognizant team and work collaboratively with… more
- Baylor Scott & White Health (Atlanta, GA)
- …Liaisons and Collectors focused on appealing hospital and professional clinical and coding denials , as well as Recovery Audit Contractors (RAC) denials . This ... + Identifies denial trends and leads initiatives to reduce preventable clinical denials . + Develops and presents performance dashboards and reports for senior… more
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