- TEKsystems (Tampa, 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 ... Epic Skills revenue cycle appeal, revenue cycle specialist , denials specialist , appeals specialist , insurance follow up, root cause analysis, EHR, EMR,… more
- Molina Healthcare (Tampa, 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 (Tampa, 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
- 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
- Molina Healthcare (Tampa, FL)
- …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... analyses of advocacy issues; and assists with documentation preparation for appeals , fair hearings or other formal/informal dispute resolution process. * Provides… more
- TEKsystems (Tampa, FL)
- …will be on the bill review team specifically working in the backlog of appeals . The Bill Review Analyst position holds accountability for accurate and timely review, ... and payment of bills to include pre-coding accuracy and adjudication of appeals /provider reconsideration requests. Pay and Benefits The pay range for this position… more
- Bristol Myers Squibb (Tampa, FL)
- …for escalation and resolution of Tier 2 queries, plan interpretation and appeals . + Responsible for ensuring internal processes are documented and updated versions ... Workday, ServiceNow, ADP and vendor management. + Certified Employee Benefits Specialist (CEBS) or equivalent Industry designation, preferred. \#LI-Hybrid If you… more
- AdventHealth (Tampa, FL)
- …analyze claim denials to perform the appropriate resolution, rebilling, and/or appeals steps. Assists with developing and implementing strategies and procedures to ... or + Certified Pension Consultant (CPC) Required or + CCS-Certified Coding Specialist Required This facility is an equal opportunity employer and complies with… more
- AdventHealth (Tampa, FL)
- …the mortality/risk adjustment reviews when assigned. . Assists with post-payment DRG appeals . . Maintains 98% accuracy rate. . Assists manager in maintaining goals ... work experience required + 1-2 years of auditing experience preferred + Certified Coding Specialist (CCS) required. Will accept RHIA or RHIT in lieu of CCS This… more