- McLaren Health Care (Mount Pleasant, MI)
- …responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Molina Healthcare (San Antonio, TX)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or... appeals and denials . * Customer service experience. * Strong organizational and… more
- Molina Healthcare (Fort Worth, TX)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers... appeals and denials . + Strong verbal and written communication skills To… 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 ... or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals ,...regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending.… more
- Molina Healthcare (Kenosha, WI)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant... appeals and denials . * Customer service experience. * Strong organizational and… more
- Molina Healthcare (Rio Rancho, NM)
- …Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Rochester Regional Health (Rochester, NY)
- …Services Hours: 37.5 SCHEDULE: Monday-Friday 8AM-4PM SUMMARY: A Medical Billing and Denials Specialist is responsible for managing the billing process, ... JOB TITLE: Collections and Denials Management Representative LOCATION: SLH DEPARTMENT: Patient Financial...accurate account resolution in line with payer requirements. + Appeals & Reimbursement Review: Conduct detailed reviews of denied… more
- Community Health Systems (Franklin, TN)
- …the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education ... of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers...RN, MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information… more
- Ochsner Health (New Orleans, LA)
- …Come make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim ... denials and underpayments to ensure accurate reimbursement. This role...staff and coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed… more
- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue...Denials Management Department by managing and resolving clinical appeals related to government audits and denials .… more