- TEKsystems (Jacksonville, FL)
- …this is not the simple call - this is a follow up that's been re-routed to the appeals specialist to do in the depth review of the denial letter to determine the ... clients Skills revenue cycle appeal, revenue cycle specialist , denials specialist , appeals specialist , insurance follow up, root cause analysis, EHR,… more
- Cognizant (Tallahassee, FL)
- ** Appeals & Grievance Specialist (remote)** This is a remote position open to any qualified applicant in the United States. **Job Summary:** We are seeking a ... dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel and… more
- Molina Healthcare (FL)
- …for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
- Molina Healthcare (Miami, FL)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Healthfirst (FL)
- …Reduction, Termination, and Suspension of services. The end-to-end process requires the Specialist to independently: + Research issues + Quality of Care Experience + ... + Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- AssistRx (Orlando, FL)
- …referral bonus! A Day in the Life as a Bilingual Patient Access Specialist : This role works directly with healthcare providers & insurance plans/payers to gather ... provided for a specific pharmaceutical product. The Bilingual Patient Access Specialist will support the healthcare providers addressing questions regarding coding… more
- HCA Healthcare (Orange Park, FL)
- …local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all ... that invests in you as an Inpatient Coding Denials Specialist ? At Parallon, you come first. HCA Healthcare has...We are looking for a dedicated Inpatient Coding Denials Specialist like you to be a part of our… more
- AssistRx (Orlando, FL)
- …provided for a specific pharmaceutical product. The Insurance Verification Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...+ Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in… more
- AssistRx (Maitland, FL)
- …coverage provided for a specific pharmaceutical product. The Patient Access Specialist will support the healthcare providers addressing questions regarding coding ... (PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move...+ Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays in… more
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