- Commonwealth Care Alliance (Boston, MA)
- …clinical, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
- The County of Los Angeles (Los Angeles, CA)
- …Board Specialist Management Assistant Operation Assistant Personnel Assistant Senior Board Specialist Senior Departmental Personnel Assistant ... Board Specialist Management Assistant Operation Assistant Personnel Assistant Senior Board Specialist Senior Departmental Personnel Assistant… more
- Johns Hopkins University (Middle River, MD)
- … and rejections processes to resolve standard issues or escalate to a more senior specialist . **Specific Duties & Responsibilities** + Uses A/R follow-up systems ... file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs the supervisor / Production Unit Manager of… more
- Johns Hopkins University (Middle River, MD)
- … and rejections processes to resolve standard issues or escalate to a more senior specialist . **Specific Duties & Responsibilities** + Uses A/R follow-up systems ... file or pull EOB batches. + Identifies and escalates non-standard appeals to a higher-level specialist . + Informs the supervisor / Production Unit Manager of… more
- The County of Los Angeles (Los Angeles, CA)
- …Board Specialist Management Assistant Operation Assistant Personnel Assistant Senior Board Specialist Senior Departmental Personnel Assistant ... Accountant I Accountant II Administrative Assistant I Administrative Assistant I, SC Appeals Hearing Specialist Board Specialist Employment Services… more
- CVS Health (Hartford, CT)
- …areas. Knowledge of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable, but a willingness ... license in physical therapist or occupational therapist * Seating Mobility Specialist (SMS) Rehabilitation Engineering & Assistive Technology Society of North… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... denial management and appeals process, as applicable, in collaboration with clinical team...appropriate, DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management Specialist position communicates clinical… more
- Independent Health (Buffalo, NY)
- …that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist - Senior will be responsible for reviewing coding and clinical ... They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise...audit tips across the team. The Clinical & Coding Specialist - Senior will support the leadership in Hospital… more
- Movn Health (CA)
- Role Summary Movn Health is seeking a highly experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts ... receivable recovery. This is a hands-on, senior -level role focused on accelerating cash flow, reducing outstanding...with a proven track record in A/R recovery, claim appeals , and payer follow-ups. Experience in startup environments and… more