- AmeriHealth Caritas (Philadelphia, PA)
- …position is responsible for the administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals , and the review ... medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial reasons,… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… 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 ... 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
- 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 ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- Texas Veterans Commission (Midland, TX)
- …rulings, and state law in the adjudication process. . Prepares and files claims and appeals with supporting evidence for successful adjudication. . Advises ... Financial Operations* **Organization:** **TEXAS VETERANS COMMISSION* **Title:** *TVC - Claims Benefit Advisor (Veterans Services Representative I)* **Location:**… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Patient Account ... Representative (PAR)** is expected to perform specific billing processes,...taking necessary actions to obtain account resolution + Submits appeals , as appropriate, for all non-clinical denials + Monitors… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Insurance ... Patient Account Representative ** is an extension of a client's business office...from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up +… more
- State of Colorado (Denver, CO)
- Part-Time, Term-Limited Complex Claims Compliance Investigator I Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5054518) Apply Part-Time, ... Term-Limited Complex Claims Compliance Investigator I Salary $58,872.00 - $70,617.00 Annually...all parties, and would be upheld if any party appeals . CIs receive training, coaching, and continuing education -… more
- Kelly Services (Glastonbury, CT)
- …terminology to process claims accurately. + Process and adjust medical claims and appeals according to established policies and procedures. + Prepare ... **Job Title:** **Medical Claims Account Manager** **Reports To:** CFO **FLSA Status:**...(SLAs). **Essential Duties and Responsibilities** _The following duties are representative of the role. Other duties may be assigned… more
Recent Jobs
-
Global Accounting Senior Associate
- Amgen (Tampa, FL)
-
Dental Hygienist
- Ascension Health (Milwaukee, WI)
-
Senior Product Manager, Visual Lease
- CoStar Realty Information, Inc. (Atlanta, GA)
-
Certified Nurse Assistant (CNA) | Long Term Care
- Avera (Aberdeen, SD)