- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal… more
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop internal compliance controls,… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist I is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following ... service units to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems, you'll play a vital role in… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Appeals Specialist II is responsible for follow-up of all appeals submitted. This individual manages denial/appeal correspondence and ... Quality work is imperative for the department to run efficiently. As an Appeals Specialist II at Community Health Systems, you'll play a vital role in supporting… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
- St. Luke's Health System (Twin Falls, ID)
- …great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical denials by ... maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to departmental operating… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory… more
- VNS Health (Manhattan, NY)
- …to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the appeals ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more