- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on ... the services/treatment rendered. JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for diagnosis and procedure code assignment and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the… more
- Molina Healthcare (San Antonio, TX)
- …appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- McLaren Health Care (Mount Pleasant, MI)
- … demonstrating accuracy/proficiency in referencing support from the medical recorddocumentation and coding guidelineswith timely and successful submissions. ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- Molina Healthcare (Rio Rancho, NM)
- …Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares documentation for further review. * ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- Centene Corporation (Pittsburgh, PA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... Responsible for reviewing, investigating and tracking member grievances and appeals , and provider claims disputes. Responsible for coordinating as necessary… more
- Molina Healthcare (Fort Worth, TX)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.… more
- Molina Healthcare (Kenosha, WI)
- …**Provider No Surprise Act** cases outcomes. . * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... * At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. *… more
Related Job Searches:
Appeals,
Appeals Specialist,
Medical,
Medical Appeals Denials Specialist,
Specialist