- UCLA Health (Los Angeles, CA)
- …to support UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to ... in clinical coding or compliance, strongly preferred + Basic understanding of audit and appeals processes, including methods, tools, and regulatory standards… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Officer** **Job Class: Revenue Tax Specialist Senior or Revenue Tax Specialist Principal** **Agency: Revenue Department** + **Job ... **Travel Required** : No + **Salary Range: Revenue Tax Specialist Senior:** $31.92 - $47.05 / hourly; $66,648 -...variety of multi-issue individual, partnership, S-corporation, estate, and fiduciary appeals arising from the audit process of… 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 ... imperative for the department to run efficiently. As an Appeals Specialist II at Community Health Systems,...Manages workflow for all incoming appeal determination letters & audit correspondence via centralized email and isynergy folders +… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...reviews with MDs, and preparation of case samples for audit review. This position works collaboratively with the AG… more
- Molina Healthcare (Tampa, FL)
- …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 clinical decisions for appeals outcomes within compliance… more
- Genesis Healthcare (Seven Fields, PA)
- …with our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up of denied ... response from the payer and takes appropriate action, including appeals , based on the type of denial. Documents all...type of denial. Documents all necessary elements; reason for denial/ audit , denial status, and action taken in the electronic… 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
- Baptist Memorial (Memphis, TN)
- Summary The Denial Mitigation Specialist - Denial Escalation Quality Assurance evaluates the adequacy and effectiveness of internal and operational controls designed ... including federal and state regulations and guidelines. The Quality Assurance Specialist will be responsible for analyzing and interpreting trends associated with… more
- Hartford HealthCare (Farmington, CT)
- …departments as needed . Manages relationship with external denials vendor. Reviews audit findings and schedules quarterly meeting to provide updates on denial ... as needed to determine the appropriate course of denial appeals . . Maintains accurate, clear, timely documentation related to.... Assists with processing HIM Coding validation denial and audit finding letters to third party vendor. . Monitors… more