- Elevance Health (Indianapolis, IN)
- …law. The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How you will ... make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective … more
- Community Health Systems (Franklin, TN)
- …or a related field preferred + 1-3 years of experience in denials management, insurance claims processing, or revenue cycle operations required + Experience in ... Coordinator is responsible for reviewing, tracking, and resolving denied claims , ensuring that appropriate appeals are submitted,...Our team members enjoy a robust benefits package including medical , dental and vision, insurance , and 401k.… more
- Humana (San Juan, PR)
- …inbound call center or related customer service experience + Previous experience processing medical claims + Bilingual (English and Spanish); with the ability to ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...+ **Must have experience in the healthcare industry or medical field** + Strong data entry skills required +… more
- CVS Health (Boise, ID)
- …meetings when required. + Understands and can respond to Executive complaints and appeals , Department of Insurance , Department of Health or Attorney General ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- Elevance Health (Indianapolis, IN)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... implications for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to… more
- Centene Corporation (Pittsburgh, PA)
- …Purpose:** Responsible for reviewing, investigating and tracking member grievances and appeals , and provider claims disputes. Responsible for coordinating as ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Health Care Service Corporation (Tulsa, OK)
- …or GED. * 3 years' experience in a customer service role OR in a health insurance or medical environment. * Knowledge of medical terminology to include ... Is Responsible For Processing And Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements… more
- Nuvance Health (Danbury, CT)
- …verbal and written communication skills * Excellent organizational skills * Prior Insurance claims processing experience helpful * Notary Public preferred but ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and...* 2 years clerical/computer experience required * Knowledge of insurance protocols preferred * Knowledge of medical … more
- St. Luke's University Health Network (Allentown, PA)
- …health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure ... 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
- CommonSpirit Health (Centennial, CO)
- …for all care sites with external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research ... and coordination of completion of medical records and utilization review processes. Identifies areas for...ability to adapt to ongoing changes within the health insurance industry in order to effect and implement positive… more