- Spectraforce Technologies Inc (Atlanta, GA)
- …patient access. Could include documenting and initiating prior authorization process, claims appeals , etc. Completes quality review of work as part of finalizing ... product. Reports any reimbursement trends/delays to management. Perform related duties and special projects as assigned. Experience and Educational Requirements: High school diploma or GED required. Requires broad training in fields such as business… more
- US Tech Solutions, Inc. (Atlanta, GA)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc.). 10% . Identify and elevate clinical inquiries to the ... pharmacist team as appropriate. 5% . Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. 5% Experience: . Preferred 0-3 years work experience required in a customer service position with high volume call center experience;… more
- Pacer Staffing (Whittier, CA)
- …with concise information for account resolution. . Pursues underpayments and complete appeals , when necessary, in a timely manner providing accurate information to ... payer. . Reviews and analyzes denied claims to determine appropriate action, accurately requesting the correct contractual adjustment according to our Commercial and Managed Care contracts. . Responds timely to insurance correspondence. . Reviews insurance… more
- Cambia Health Solutions, Inc (Renton, WA)
- …reviews)Understanding of claims, billing and codingFacets/FEP/Claims systems in appeals , SIUClaims processing, claims configuration rolesUnderstanding of Medical and ... reimbursement policiesCPC Certified or willing to get CPC Certified as condition to position.What You Bring to Cambia: Qualifications: Bachelor's degree in Business Administration or a related field3 years of experience in a healthcare related environment… more
- MultiPlan (Atlanta, GA)
- …Integrity Reporting and Analytics ecosystem.2. Understand claims flow, savings identification, appeals processing, and fraud, waste, and abuse detection by the ... Payment Integrity Analytics system. Be able to work with multiple teams to create business and system requirements for the Reporting and Analytics ecosystem.3. Analyze system needs and design appropriate reporting solutions.4. Maintain complex database… more
- US Tech Solutions, Inc. (Atlanta, GA)
- …other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). . Identify and elevate clinical inquiries to the pharmacist ... team as appropriate . Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. Experience: . 0 to 3 years of related work experience. Skills: . Prior Authorization . Call handling experience. Education: . High School diploma or GED… more
- ProKatchers (Alhambra, CA)
- …and electronic claims; process tracers, denial and related correspondence; initiate appeals ; compose and submit appeal letters specific challengeable denial issues ... consistent with the most update American Medical Association Current Procedural Terminology. Must demonstrate a positive demeanor, good verbal and written skills, and must be professional in both appearance and approach. Will maintain consistent productivity… more
- Beacon Hill Staffing Group, LLC (Cleveland, OH)
- …requirements, submitting and monitoring monthly bills, resolving rejections, creating appeals , and generating reports. The role involves using internal systems ... like Footprints for tracking and completing requests.Qualifications:Bachelor's degree or equivalent experienceAt least 3 years of experience with LEDES files, eBilling Hub, and e-billing websitesExperience with legal billing software (Aderant preferred) and… more
- UNC Health (Chapel Hill, NC)
- …communities we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse. This person is based at the Hedrick building and ... is 100% on-site. This individual combines clinical, business, and regulatory knowledge to reduce significant financial risk caused by concurrent and retrospective denial of payments for rendered services. This individual is highly developed in assessing… more
- A-Line Staffing Solutions (Haverhill, FL)
- …HMO, Concurrent Review, Retrospective Review, Managed Care, Medical Claims, Appeals , Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, ... Patient Counselor, Healthcare, Inbound Calls, Outbound Calls. more
