- Insight Global (Los Angeles, CA)
- …the Health Plan staff, Plan participants, business managers, health care providers, medical insurance companies and related governmental agencies, and medical ... next steps need to be taken. * Assist with research to advise management on medical claims issues and assist with developing guidelines for use by the examiners… more
- Baylor Scott & White Health (Dallas, TX)
- …handling Responsibility for the preparation of summaries and files for denials, appeals , medical opinions, subrogation and litigation.1. Collection of documents ... for the approval of lost wages for payroll and for all approvals of medical bills per claim file.Pay and process claims within designated authority levelPerforms… more
- Humana (Juneau, AK)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... caring community and help us put health first** The Medical Director actively uses their medical background,...of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of… more
- Robert Half Office Team (Lakewood, NJ)
- … medical records using computer systems while ensuring accuracy and completeness. * Log claims and appeals requests as directed by the Claims Department ... as requested by management. * Maintain clean and accurate spreadsheets to track claims -related data. * Organize medical records based on provided checklists and… more
- MetLife (Cary, NC)
- …meeting all key performance indicators * Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and ... fast-paced environment and in accordance with state and department of insurance regulations. * Develop actions plans and identify return to work potential * Provides… more
- Guidehouse (Lewisville, TX)
- …office and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up + Customer Service ... + Billing + UB-04 claims + Complete all business-related requests and correspondence from...creating a diverse and supportive workplace. Benefits include: + Medical , Rx, Dental & Vision Insurance +… more
- Stanford Health Care (Palo Alto, CA)
- …to effectively facilitate work groups to successful outcomes. + Knowledge of medical and insurance terminology, MS-DRG, APR-DRG, CPT, ICD coding structures, ... the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong… more
- Houston Methodist (Houston, TX)
- …impacting AR collections. **FINANCE ESSENTIAL FUNCTIONS** + Expedites and maximizes payment of insurance medical claims by contacting third party payers and ... responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist...resolution. Engages the coding follow up team for any medical necessity or coding related appeals . +… more
- Intermountain Health (Murray, UT)
- **Job Description:** This position provides expertise in the areas of appeals and grievances for highly regulated insurance plans with unique plan designs, ... specialists, medical directors and various leadership members. + Prepares appeals for review by appropriate committees, internal medical directors, and… more
- Covenant Health Inc. (Knoxville, TN)
- … insurance /precert verification, registration, Health Information Management (HIM), coding, claims management/ insurance follow-up or appeals etc.). Will ... and/or appeal of rejected, denied, unpaid, or improperly paid insurance claims . This position is responsible for...no more than one year of experience. Knowledge of medical terminology and insurance payer rules, state… more