- Optum (San Juan, PR)
- …or routed to other departments Classify and set up the case in the appeals system Ensure accurate data entry based on research Ensure all required ... will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a… more
- CenCal Health (Santa Barbara, CA)
- …benefits and supplemental benefits, providers, referrals, authorizations, claims , transportation, interpretation and translation needs, alternative formats ... needed and intake of grievances/ appeals . Hours of operation for the CareConnect Call Center...in the appropriate systems, and ensure timely and accurate data entry. Support departmental compliance and quality assurance activities.… more
- PACS (Cedar Creek, TX)
- …documentation review. Coordinates denials management activities of the department to ensure that claims are timely and/or appeals timely and in accordance with ... and /or Speech Language Pathology. Proficient in computer skills such as inputting data into programs such as Casamba and Point Click Care. Language Skills Ability… 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)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- St. Luke's University Health Network (Allentown, PA)
- …health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... 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
- Penske (Reading, PA)
- …audits, including negotiating with auditors and interfacing with taxing jurisdictions. -Perfect appeals and refund claims . -The position will require the ability ... and efficiencies are met. -The ability to query, analyze data , and map detailed processes coupled with analytical skills...Requirements:** -The physical and mental demands described here are representative of those that must be met by an… more
- MyFlorida (Fort Lauderdale, FL)
- 856378-EMPLOYMENT SECURITY REPRESENTATIVE II-LW - 40046185 Date: Jul 21, 2025 The State Personnel System is an E-Verify employer. For more information click on our ... . Requisition No: 856378 Agency: Commerce Working Title: 856378-EMPLOYMENT SECURITY REPRESENTATIVE II-LW - 40046185 Pay Plan: Career Service Position Number:… more
- TEKsystems (Roseville, CA)
- …via phone, in person, and written correspondence + Explain plan benefits, eligibility, claims processing, and appeals + Draft eligibility, sick leave, and basic ... Job Title: Member Services Representative Location: Professional corporate office located in Roseville,...to support our healthcare members with eligibility, benefits, and claims inquiries. This role requires strong communication skills, a… more
- UNC Health Care (Chapel Hill, NC)
- …**Job Responsibilities:** + Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals , response to denials, and ... payer, system or escalated account issues. + May maintain data tables for systems that support PB Claims... data tables for systems that support PB Claims operations. + Evaluate carrier and departmental information and… more
