- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, including any escalated step of… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals /grievance correspondence, and ... organizing and tracking information to facilitate and expedite processing of appeals /grievances received from a variety of sources. Responsible for more complicated,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related… more
- Robert Half Accountemps (Los Angeles, CA)
- …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , will be in ... complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your extensive… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- 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
- St. Luke's Health System (Twin Falls, ID)
- …place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist , is responsible for managing client medical denials by ... maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to departmental operating… 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
- Lincoln Financial (Lincoln, NE)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more