- Rochester Regional Health (Rochester, NY)
- …the payer website, coverage policies and/or phone calls to the payer. Submit corrected claims and appeals . + Process account adjustments and refunds as needed ... a Medical Office environment preferred . + Basic knowledge of medical billing, cording, collection processes, insurance policies and governmental regulation… more
- Alameda Health System (Oakland, CA)
- …actively appeals denied cases when necessary and assists physicians with appeals . Maintains minimal denial rates by Medicare, MediCal , private and contracted ... Their responsibilities span from managing admissions to ensuring clean claims , identifying trends, and optimizing resource utilization. This role supports… more
- Owens & Minor (Downers Grove, IL)
- …the needed Rx's, PA's and medical justification to facilitate payment of claims for initial and review/ appeals payments. + Ability to edit and resubmit ... our teammates. Owens & Minor teammate benefits include: + Medical , dental, and vision insurance , available on...claims for payment. + Prepares and reviews clean claims for submission to various insurances either electronically or… more
- BayCare Health System (Clearwater, FL)
- …+ Conduct thorough investigations by gathering relevant information, documentation, and medical records. + Triage, plan, and execute intake of Appeals ... management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. + Participate in… more
- Elevance Health (Ashburn, VA)
- …+ Coordinates prompt claims resolution through direct contact with providers, claims , pricing and medical management department. + Identifies and reports on ... provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. May be responsible for coordinating non-negotiated… more
- Molina Healthcare (UT)
- …recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. ... and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. +… more
- Manulife (ME)
- …been followed in accordance with established guidelines and policies. + Audit medical record summaries to ensure documentation is in accordance with our established ... research projects pertaining to risk assessment. + Process formal underwriting appeals and complaints. + Review underwriting fraud referrals for appropriateness and… more
- Fair Haven Community Health Care (New Haven, CT)
- …Fair Haven prides itself on efficient billing services including the filing of claims , appeals processing, authorizations, and, above all, a great passion for ... data entry, documentation review and encounter posting + Prepares and submits clean claims to various insurance companies either electronically or by paper when… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …This position is responsible for pulling medical records to submit with claims and appeals as required by payors. Responsible to validate and accurately ... register new patients in the system, including patient demographics, verifying insurance , eligibility and claim information is accurate. Incumbent will verify… more
- Trinity Health (Albany, NY)
- …and regularly evaluated on competencies and quality of work. + Leads oversight of appeals denied claims for elated services, drugs, treatments and supplies. + ... authorizations. + Facilitates communication with care team and providers + Appeals denied authorizations for related services, drugs, treatments, and supplies. +… more