- HCA Healthcare (Frankfort, KY)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Appeals Specialist with Parallon you can be a part of an organization ... need to succeed in our organization. We are looking for an enthusiastic Appeals Specialist to help us reach our goals. Unlock your potential! **Job Summary and… more
- Molina Healthcare (Lexington, KY)
- …+ 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 (Bowling Green, KY)
- **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
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …and denials from insurance companies and re-files the claim. + Files appeals to carriers according to prescribed guidelines, documents all information related to ... appeals and follows up. + Scans and uploads patient clinical documents into medical chart. + Ensures all provider services are accounted for and billed.… more
- Intermountain Health (Frankfort, KY)
- **Job Description:** The Pre-Access Authorization Specialist I is responsible for accurately verifying and completing insurance eligibility, securing prior ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- CVS Health (Frankfort, KY)
- …Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- Option Care Health (Frankfort, KY)
- …Assists with Billing and Collection Training and completes "second level" appeals to payers. **Job Description:** **Job Responsibilities:** + Submits timely, ... accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are… more
- Cardinal Health (Frankfort, KY)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes… more
- Evolent (Frankfort, KY)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more
- Molina Healthcare (Owensboro, KY)
- …claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances. * Coordinates with Corporate and Business Development ... Provides training and guidance as needed to the Contract Managers and Contract Specialist (s). * Helps develop and utilize standardized contract templates and Pay for… more