- 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 ... to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems,...activity in the Appeal Tracker. + Submits requests for medical records, ub's, and itemized bills as needed. +… more
- 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
- 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 ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… 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, CA, ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… 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 ... imperative for the department to run efficiently. As an Appeals Specialist II at Community Health Systems,...Tracker, Cerner/ClaimIQ/Artiva, or other programs + Submits requests for medical records, ub's, and itemized bills as needed +… more
- Molina Healthcare (Tampa, FL)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously ... + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training,… more
- LA Care Health Plan (Los Angeles, CA)
- …and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on ... Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- Weill Cornell Medical College (New York, NY)
- Title: Revenue Cycle Specialist -Revenue Integrity ( Remote ) Location: Midtown Org Unit: AR - Coding Medicine Work Days: Weekly Hours: 35.00 Exemption Status: ... claim status and billing guidelines to substantiate corrected claim submissions, written appeals , coding and medical necessity reviews. + Researches and… more
- St. Luke's University Health Network (Allentown, PA)
- …, case resolution, and impact on revenue and trending. + Coordinates RAC appeals for complex case reviews for medical necessity, including determining if ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for... reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists… more
- AdventHealth (Altamonte Springs, FL)
- …we are even better. **Shift** : Full-time; Monday-Friday **Job Location** : Remote **The role you will contribute:** This position is responsible for investigating ... best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and...obtain further patient information to be used in the appeals process if necessary. . Provide reports, education, and… more