- Avera (Sioux Falls, SD)
- …Communicate coding updates and changes to appropriate individuals. + Coordinate and/or complete insurance appeals on denied claims due to coding issues. + Assist ... functions when unable to resolve them and their remittances. + Review all insurance bulletins and refers information to other personnel as appropriate. + Provide… more
- Conduent (Baton Rouge, LA)
- …you eager to learn new skills and help adults in need?** As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH) Office ... **In this remote role, you will:** + Review decision/denial letters on new appeals requests received, research data and materials to accumulate evidence, draft and… more
- Centene Corporation (Jefferson City, MO)
- …utilization and health care quality + Oversee and actively participate in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in ... and other ad hoc committees + Collaborate closely with clinical teams, appeals team, and network providers to ensure understanding and adherence to utilization… more
- Robert Half Office Team (Minneapolis, MN)
- …looking for a rewarding remote role in healthcare administration? This Clinical Appeals Representative position offers the opportunity to make a meaningful impact ... while working from the comfort of your home. As a Clinical Appeals Representative, you will play a key role in managing the intake and processing of grievances and… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- University of Washington (Seattle, WA)
- …patients, their families, and their caregivers + Manage prescriptions and assist with insurance appeals for specialty medications + Handle the care coordination ... and continuity of care process + Administer specialty medications, including intramuscular injections + Support providers during minimally invasive procedures **REQUIREMENTS** + 2 years of recent ambulatory clinic or medical-surgical nursing experience +… more
- Humana (Lincoln, NE)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
- Centene Corporation (Austin, TX)
- …optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and ... medical necessity appeals . + Participates in provider network development and new...work in the areas of Health Administration, Health Financing, Insurance , and/or Personnel Management is advantageous. + Experience treating… more
- Ochsner Health (New Orleans, LA)
- …The Appeals Specialist is responsible for managing and resolving insurance claim denials and underpayments to ensure accurate reimbursement. This role involves ... Preferred - + Experience in healthcare or revenue cycle - specifically insurance claim denials. + Strong analytical and organizational skills. + Excellent… more
- Elevance Health (Nashville, TN)
- **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... Perform cost report reopenings. + Under guided supervision, participate in completing appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more