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The Appeals Specialist will lead the organizations denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials.
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Job Description - Senior Appeals Specialist-Medicare Advantage (2400193) Senior Appeals Specialist-Medicare Advantage. 5 years as an Appeals Specialist or equivalent experience in health insurance claims, customer service, billing, or related operations preferred.
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Under the supervision of the Appeals and Grievance Manager, assist with soliciting non-clinical information from Participating Physical Group (PPG) and specialist concerning follow care related to care management.
$47,840 - $68,474 a yearFull-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Required: Certified Professional Coder (CPC) or Certified Coding Specialist –Physician Based (CCS-P) Certified Coding Associate (CCA) Job Title: Coding and Reimbursement Specialist. Work with Accounts Receivable team to analyze denials, interpret medical policies and assist with preparation of appeals.
$54,186 - $66,936 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The CLU handles both post-conviction proceedings in the trial court and appeals before the Idaho Supreme Court. Each in-house team is composed of a lead attorney, second attorney, fact investigator, mitigation specialist, and administrative assistant.
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Overview Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana Farber Cancer Institute and various health plans.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare relevant reports regarding trends in denials.
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The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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The Senior DME billing code compliance and appeals specialist will play a crucial role in ensuring that our DME product complies with the billing codes and regulations set by Medicare and all federally funded payers.
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Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) certification. The Billing & Accounting Specialist will be responsible for accurately processing billing documentation, handling claims, ensuring compliance with Medicare and Medicaid regulations, and assisting with accounting related tasks.
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As part of a Career Progression Group, vacancies may be filled from this recruitment as a Workforce Development Specialist 1, 2, or 3 depending on the level of experience of the selected applicant.
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Case types include Adoption, Civil, Criminal, Family Law, Guardianship/Conservatorship, Juvenile Delinquency, Juvenile Dependency, Juvenile Emancipation, Lower Court Appeals, Mental Health, Probate, Protective Orders and Severance cases.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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We are hiring a Public Benefits Staff Attorney to represent clients in all stages of the application process for public benefits (SSDI/SSI appeals and others), support workers filing claims in small claims court and represent some clients at employment-related administrative agency hearings.
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Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections. Claim Management: Handle claims submission, review denials, and coordinate appeals with insurance providers.
Full-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Avosys is seeking a Bexar County Remote Registered Nurse - Medical Review Specialist to work remotely to review Medicare claims. Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the “Services”) in accordance with CMS (Centers for Medicare & Medicaid Services) requirements.
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