• Appeals Specialist

    HCA Healthcare (Brentwood, TN)
    …**_Note: Eligibility for benefits may vary by location._** We are seeking an Appeals Specialist for our team to ensure that we continue to ... do. We want you to apply! **Job Summary and Qualifications** The Appeals Specialist will be responsible for performing end-to-end tasks for technical appeals… more
    HCA Healthcare (01/08/26)
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  • Clinical Denial Coding Review Specialist

    HCA Healthcare (Brentwood, TN)
    …Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have an exciting opportunity for ... of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is valued? If you are… more
    HCA Healthcare (12/17/25)
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  • Senior Coding Specialist

    Houston Methodist (TN)
    Telecommute - Must Reside in TX At Houston Methodist, the Sr Coding Specialist position is responsible for applying correct coding conventions to patient charge ... the electronic health record. In addition, the Sr Coding Specialist position is responsible for reviewing, correcting and appealing...posting to the assigned work queues. + Investigates and appeals unpaid, denied and partially paid claims by third… more
    Houston Methodist (01/13/26)
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  • Clinical Utilization Review Specialist

    Community Health Systems (Franklin, TN)
    **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
    Community Health Systems (01/13/26)
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  • Fund Control Specialist

    Wellpath (Franklin, TN)
    …point of care support. **How you make a difference** The Fund Control Specialist performs pre- and post-payment audits of external claims; ensures that the company ... with standards, audit criteria, contracts, and policies. + Perform claims appeals and high-dollar reviews, including contract compliance checks and written… more
    Wellpath (01/07/26)
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  • Clinical Pharmacy Specialist

    Actalent (Chattanooga, TN)
    Job Description We are seeking a detail-oriented and customer-focused Pharmacy Support Specialist to join our team. In this role, you will: + Respond to calls and ... members, and member representatives regarding pharmacy prior authorizations, exceptions, and appeals . + Enter authorizations and test claims into the pharmacy… more
    Actalent (01/06/26)
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  • Senior Claim Benefit Specialist

    CVS Health (Franklin, TN)
    …and timely support. + Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Handles phone and written ... inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals . + Identifies and reports claim overpayments, underpayments, and any… more
    CVS Health (12/16/25)
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  • Clinical Pharmacy Specialist

    Actalent (Chattanooga, TN)
    …and/or members/members representatives for pharmacy prior authorizations, exceptions, and appeals Enter authorizations and test claims into the pharmacy benefit ... system to ensure appropriate claim adjudication Perform system edits, data entry, and complete tracking logs Assist with departmental audits and quality improvement activities Skills Pharmacy, Cpht, Call center, PTCB Top Skills Details Pharmacy,Cpht,Call… more
    Actalent (01/06/26)
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  • DRG Denials Auditor

    Community Health Systems (Franklin, TN)
    …appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education to include ... products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop...RN, MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information… more
    Community Health Systems (12/09/25)
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  • Coding Spec-Clinic

    Covenant Health Inc. (Knoxville, TN)
    Overview Coding Specialist , Centralized Coding [Type, HPPP, Shift] Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with ... personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. + Reviews medical… more
    Covenant Health Inc. (01/01/26)
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