- Martin's Point Health Care (Portland, ME)
- …Plan benefits, particularly as it relates to Member Appeals + Cross-trains with Medicare Appeals Specialist to perform functions as needed Overall Key ... Place to Work" since 2015. Position Summary Job Description Position Summary: The Appeals Specialist ( Medicare or US Family Health Plan) is responsible for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...and reviews findings with all levels of Payment Resolution Specialist for further review. Serve as a resource to… more
- Abbott (Plano, TX)
- …Our 114,000 colleagues serve people in more than 160 countries. **Sr. Appeals Specialist , Patient Therapy Access Team** **Position Location: 6600 Pinecrest ... Our location in **Plano, TX** currently has an opportunity for a **Sr. Appeals Specialist ** . This role is responsible for facilitating and assisting… more
- Universal Health Services (Bonham, TX)
- …day. TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare ... payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II...A minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required. A minimum of 3-5 experience in… 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
- McLaren Health Care (Flint, MI)
- We are looking for an Appeals Specialist to join us in leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren Health Care ... Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana… more
- Molina Healthcare (TX)
- …discussed during our interview process._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions ... for appeals outcomes...MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including… more
- CareOregon (Portland, OR)
- …quality assurance operational activities for transportation services covered under Medicaid and Medicare lines of business, including appeals and grievances, as ... Job Title Grievance System Specialist Exemption Status Non-Exempt Department Transportation Manager Title...implementation of policies and procedures which meet Medicaid and Medicare Grievance and Appeals system requirements and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …knowledge (Medicaid, Medicare ) and case management process (prior authorization and appeals ) required + Ability to multi-task and adapt to changing priorities + ... CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and...Ensures compliance with federal and state regulations, MA Medicaid, Medicare and Managed Care payment systems. Monitors, consults, and… more
- TEKsystems (Houston, TX)
- …entry,Insurance verification,Health care,Medical,Medical billing,Health insurance, medicare ,claim,insurance companies,medical terminology,insurance coverage,patient ... and denials. Payers include but are not limited to Medicare , Medicaid, Blue Cross, and commercial health insurance carriers....increase cash flow Day to Day Duties: - Each specialist will be assigned an inventory to work. New… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit support ... processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all...Acts as a resource and has expert knowledge of Medicare , Medicaid, ICD-10 Coding and OASIS and other applicable… more
- Conduent (Los Angeles, CA)
- …where individuality is noticed and valued every day. **Insurance/Collections Specialist ** **Pay $18-20hr based on experience** The Insurance/Collections ... not limited to analyzing the overpayment data, and handling disputes and appeals from providers, and navigating difficult collection situations to resolution. Must… more
- Houston Methodist (Katy, TX)
- …of hospital billing and insurance follow up experience is required** Medicare experience is preferred** Epic experience is preferred** Hybrid position-location: 701 ... S Fry Rd 77450 (Katy)** At Houston Methodist, the Accounts Receivable Specialist position is responsible for billing and follow up of insurance or institutional… more
- The New Jewish Home (Bronx, NY)
- …Finance Department in Waters Place, Bronx is seeking a full time Managed Care Billing Specialist to join our team. The Managed Care Specialist is responsible for ... create project spreadsheets for submission to payers, write reconsideration appeals and send to MCOs, and be able to...skilled nursing home billing is required + Must Understand Medicare , Managed Care, Medicaid (NY) billing and reimbursement +… more
- Sharp HealthCare (San Diego, CA)
- …information necessary for activities related to Medical Groups' Quality and Appeals processes. + Demonstrates knowledge of department policies and procedures ... regulatory and health plan guidelines for issuance of notice letters ie Medicare notice of non-coverage, Commercial notice of non-coverage or Exhaustion of Benefit… more
- Beth Israel Lahey Health (Burlington, MA)
- …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands on coding, documentation review and other coding needs ... with the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17....guidelines. 2. Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare 's yearly fee schedule, … more
- MD Anderson Cancer Center (Houston, TX)
- …employees and the public. **Summary** The primary purpose of the PBS Specialist position is to follow-up on claims within regulatory guidelines. The PBS ... Specialist must ensure that all claims have a follow-up...delay in payments. Makes recommendations for resolution 7. Pursues appeals when available. Initiates communication with coding team and… more