- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity ... a winning culture and make an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something you would be interested in,… more
- Humana (Helena, MT)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal...a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents +… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for ... billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity… more
- CVS Health (Hartford, CT)
- …to in‐ coming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. ... do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experi‐ ence by… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management ... and routes issues to appropriate individuals, assists in resolution of non- clinical issues as needed + Facilitates and arranges acquisition of post-acute… more
- CVS Health (Phoenix, AZ)
- …to incoming correspondence and internal referrals. -Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. ... work in Arizona. Responsibilities below include, but not limited to: -Customer Service Representative is the face of Aetna and impacts members' service experience by… more
- Guidehouse (Birmingham, AL)
- …+ Works all denials taking necessary actions to obtain account resolution. + Submits appeals , as appropriate, for all non- clinical denials + Monitors all denials ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...None **What You Will Do** **:** The Patient Account Representative (PAR) is expected to perform specific billing processes,… more
- Guidehouse (Lewisville, TX)
- …+ Works all denials taking necessary actions to obtain account resolution + Submits appeals , as appropriate, for all non- clinical denials + Monitors all denials ... **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:**...None **What You Will Do** **:** The **Patient Account Representative (PAR)** is expected to perform specific billing processes,… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Business Office Representative Department: Location: Hours Per Week: Schedule: Sign-On Bonus: SUMMARY: Ensure full reimbursement is received by RRH for ... clinical services rendered including professional, long-term/home care and hospital...phone calls to the payer. Submit corrected claims and appeals . + Process account adjustments and refunds as needed… more
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