- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... determine if an a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5055524) Apply Appeals Referee Salary $77,379.00 - $117,497.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team in the Hermitage...B. I have experience as a legal or non-legal representative of parties to quasi-judicial administrative hearings conducting direct… more
- Intermountain Health (Harrisburg, PA)
- …such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications), ... required- Familiarity with electronic remittances, required **Physical Requirements** + Interact with others by effectively communicating, both orally and in writing + Operate computers and other office equipment requiring the ability to move fingers and hands… more
- WellSpan Health (Chambersburg, PA)
- …WQ as required. Track, trend and investigate denials with insurance companies. Send appeals when required. Make sure account is ready to drop to secondary insurance. ... Bills any late charges when necessary. 36. Keys appropriate adjustments if claims have processed correctly. 37. Properly corrects insurance when receiving denials for incorrect coverage. Rebill account. 38. Enter or update patient data into computer. 39.… more
- Cardinal Health (Harrisburg, PA)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- CVS Health (Harrisburg, PA)
- …new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with credentialing/re-credentialing and ... contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. + Work hours will be… more
- Highmark Health (Harrisburg, PA)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... a resource for technical staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy… more
- Highmark Health (Harrisburg, PA)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Justice, Bureau of Prisons/Federal Prison System (Pittsburgh, PA)
- …in security designations and custody classification. Experience entering and tracking appeals filed by inmates and assisting with researching and preparing responses ... to inmate appeals . Experience in providing assistance to contractors in the...a position in a Bureau of Prisons institution. The representative rate for this position is 84,089 per annum… more
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