- HCA Healthcare (Orem, UT)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Appeals Specialist with Parallon you can be a part of an organization ... need to succeed in our organization. We are looking for an enthusiastic Appeals Specialist to help us reach our goals. Unlock your potential! **Job Summary and… more
- Intermountain Health (West Valley City, UT)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. Fully remote position! +… more
- Molina Healthcare (Provo, UT)
- **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
- Intermountain Health (Salt Lake City, UT)
- **Job Description:** The Pre-Access Authorization Specialist II serves as a subject matter expert (SME) in the department to accurately verifying and completing ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- CVS Health (Salt Lake City, UT)
- …Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- Intermountain Health (Salt Lake City, UT)
- **Job Description:** The Pre-Access Authorization Specialist I is responsible for accurately verifying and completing insurance eligibility, securing prior ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- University of Utah Health (Salt Lake City, UT)
- …+ Resolves clinical and/or authorization denials through CARC analysis and appeals - including clinical documentation review and coordination with UR and/or ... attending physician. + Acts as patient advocate in the resolution of balances. + Prepares and monitors high dollar spreadsheets and/or payer escalations spreadsheets, as assigned. + Escalates claim issues internally to other key departments including Coding,… more
- Cardinal Health (Salt Lake City, UT)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes… more
- Evolent (Salt Lake City, UT)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more
- Molina Healthcare (Salt Lake City, UT)
- …claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances. * Coordinates with Corporate and Business Development ... Provides training and guidance as needed to the Contract Managers and Contract Specialist (s). * Helps develop and utilize standardized contract templates and Pay for… more