- CenterLight Health System (NY)
- JOB PURPOSE: The Claim Appeals and Audit Specialist ...by timely and accurate processing of claims appeals and performing claims audit , ... to determine if system or procedural changes could enhance claim workflow and efficiency. + Analyze patient and medical...is strongly preferred. + Experience in claims appeals and/or claims audit within… more
- Genesis Healthcare (PA)
- …with our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up of denied ... claims from all commercial and contracted payers. The follow...This may include writing detailed appeal letters supporting the claim and reimbursement. Performs all appeals and… more
- Molina Healthcare (Tacoma, WA)
- …following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...This position will performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied… more
- Molina Healthcare (Covington, KY)
- …following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... 3+ years of Medicare and Medicaid Inpatient and Outpatient Appeals and Claims experience Previous knowledge with InterQual or MCG guidelines **Preferred… more
- Independent Health (Buffalo, NY)
- …correlating coding complexity. They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise and ... knowledge and audit tips across the team. The Clinical & Coding Specialist -Senior will support the leadership in Hospital Audit in accomplishing all aspects… more
- Beth Israel Lahey Health (Burlington, MA)
- …review, and interpret third-party payments, adjustments, and denials. Initiates corrected claims , appeals , and analyzes unresolved third-party and self-pay ... maintains open communication with third-party payor representatives to resolve claims issues. Review claim forms for the...future denials and edits of the same nature. Initiates claim rebilling, written appeals , or corrections, and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …significance, medical necessity, coding and billing. + Comprehensive oversight of appeals , medical record audit pipeline, financial projections, and operational ... your true colors to blue. What We Need The Audit Manager will lead the Professional and Hospital Bill...+ Active Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) through AHIMA or AAPC is required +… more
- State of Colorado (Denver, CO)
- FAMLI Overpayment Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4922200) Apply FAMLI Overpayment Specialist Salary $57,708.00 ... Specialists will be accountable for determining, processing and collecting on claim overpayments. Position reports to the Collections & Debt Management Supervisor.… more
- MyFlorida (Tallahassee, FL)
- …on the link: http://www.floridajobs.org/ The Work You Will Do: The OPS Employment Program Specialist is a member of the Claims Processing team of the Division ... 851484 - OPS EMPLOYMENT PROGRAM SPECIALIST - 40099878 Date: Apr 25, 2025 The...knowledge, skills, and abilities. Responsible for reviewing and handling claims associated with CONNECT Workflow Queues, Corrected Desk Pay… more
- State of Colorado (Denver, CO)
- SNAP Automated Systems Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4813151) Apply SNAP Automated Systems Specialist Salary ... general program assistance to county staff responsible for the administration, issuance, and claims collection of food benefits in SNAP. This position is also the… more