- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- CommonSpirit Health (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Robert Half Legal (Mountlake Terrace, WA)
- …Robert Half is partnering with a Healthcare Organization searching for their next appeals specialist . This is an excellent opportunity for a motivated ... professional who thrives in a fast-paced environment. They are looking for someone to join ASAP! Location: Remote Pay Rate: $21-23 per hour Duration: 3+ months potential for extension Schedule: M-F, 8am-5pm Responsibilities: + Research, coordinate, and resolve… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... diagnosis and procedure codes to assure properly assigned MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures that the most accurate and descriptive codes from the AHA ICD-9-CM/ICD-10-CM/PCS… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Scripps Health (San Diego, CA)
- …**Job:** **Business Office* **Organization:** **Scripps Health Corp* **Title:** *Public Resource Specialist - Programs & Appeals * **Location:** *Central San ... Scripps Mercy Hospital Chula Vista as a Public Resource Specialist . In this position, you will be responsible for...of the applications, through to the highest level of appeals while adhering to all policies on fraud/abuse and… more
- Centene Corporation (Pittsburgh, PA)
- …Responsible for reviewing, investigating and tracking member grievances and appeals , and provider claims disputes. Responsible for coordinating as necessary ... member grievances and complaints + Screen all incoming grievances, appeals and provider claim disputes to ensure they are...daily entries into the DBHS Office of Grievance and Appeals database. + Coordinate with all relevant departments, as… more
- Health Care Service Corporation (Tulsa, OK)
- …Is Responsible For Processing And Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements ... In Writing, To All Inquiries Involving Member*S Requests For Appeals . May Train And Mentor Less Experienced Appeals... Appeals . May Train And Mentor Less Experienced Appeals Specialists. THIS IS NOT A FULLY REMOTE POSITION.… more
- Nuvance Health (Danbury, CT)
- …44, MOON, Connecticut notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * ... Assists with informing Managed Care contracting team with necessary contractual language to protect organization financial position specific to inpatient medical necessity requirements. * Employs creative solutions with team members and leadership to prevent… more