- TEKsystems (Raleigh, NC)
- …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 ... Epic Skills revenue cycle appeal, revenue cycle specialist , denials specialist , appeals specialist , insurance follow up, root cause analysis, EHR, EMR,… more
- Healthfirst (NC)
- …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
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …to risk management issues.. Notifies, educates and guides providers on the appeals process. Completes NPDB report and enter information as required. Provide ... complete the tort claim process. Coordinate and schedules review of Veterans Benefits Appeals cases. Manages the process for handling all small claims and those… more
- Lewis Tree Service, Inc (Concord, NC)
- Description The AR Revenue Cycle Specialist is responsible for working in conjunction with operations personnel to accurately report production completed including ... receivable collection and analyzing profit and loss statements weekly. The specialist must have expertise in insurance follow-up processing and be knowledgeable… more
- North Carolina State University (Raleigh, NC)
- …UTS/UNC Partnership Location: Chapel Hill, NC Essential Job Duties: This Insurance Specialist position offers both dental and medical insurance services . The ... Insurance Specialist works in all areas of billing and reimbursement,...denied claims, following up on those investigations, and submitting appeals for those denied claims; + Verifying essential documentation… more
- UNC Health Care (Raleigh, NC)
- …the Health Care System at each of the four levels of appeals when applications are denied. **Responsibilities:** 1. Obtains detailed personal, financial and ... Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local,… more
- CVS Health (Raleigh, NC)
- …**Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all… more
- KPH Healthcare Services, Inc. (Greensboro, NC)
- **Overview** The Revenue Cycle Management Specialist - Collections responsibility is to ensure timely collection of outstanding balances. **Responsibilities** + ... complex or uncollectible accounts to management for further action. + Submit appeals /claim corrections as needed within timely filing limits. + Utilize billing… more
- Intermountain Health (Raleigh, NC)
- …providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding ... review, audit findings, and appeal strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex… more
- UNC Health Care (Goldsboro, NC)
- …the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation ... to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates the denial team in order to establish appeals… more