- Cambia Health Solutions, Inc (Tacoma, WA)
- Appeals Specialist IRemote within WA, ID, OR, and UTPrimary Job Purpose:Responsible for all activities associated with requests for Provider Billing Disputes and ... Appeals . Includes analysis, preparation, evaluation of prior determinations, coordination of clinical review if needed, decision making, notification, and completion.… more
- APN Consulting, Inc (TX)
- Title: Healthcare - Appeals Specialist IREMOTE6 monthsJob Description:* Will the position be 100% remote? yes* Are there are time zone requirements? Prefer no more ... skills, and meet the description in the job chosen ( appeals specialist I)* What are the day to day...Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Client members, providers… more
- Creative Financial Staffing (Cleveland, OH)
- APPEALS SPECIALIST WHY YOU SHOULD BE THE APPEALS SPECIALIST Our client is a law firm located in Cleveland, Ohio Hybrid 1 day per week Great health benefits, ... Paid Maternity leave and tuition assistance RESPONSIBILITIES OF THE APPEALS SPECIALIST Perform appeal edits and create appeals... APPEALS SPECIALIST Perform appeal edits and create appeals in a variety of ebilling websites. Record all… more
- Creative Financial Staffing (Cleveland, OH)
- Appeals Specialist About the company and Appeals Specialist opportunity: Our client is a law firm located in Cleveland, Ohio Hybrid 1 day per week Great health ... and tuition assistance Essential Duties and Responsibilities of the Appeals Specialist: Perform appeal edits and create appeals... Appeals Specialist: Perform appeal edits and create appeals in a variety of ebilling websites. Record all… more
- Accounting Now (Tampa, FL)
- Medicare Appeals Specialist Do you like challenging payers? Enjoy that feeling of satisfaction when your appeal is overturned? Then, this position may is right for ... you! The ideal candidate will be well versed in the Medicare managed care appeals and grievance process. Must have strong knowledge of Medicare payer guidelines and… more
- Accounting Now (Tampa, FL)
- …advanced-level work related to clinical and coding denial management and appeals follow-up. The individual is responsible for conducting a comprehensive review ... to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely manner. This...fax, etc Documents and summarizes all rationale for all appeals in EPIC. Documents communications with medical office staff… more
- Army National Guard (Columbus, OH)
- …research court decisions and Army regulations, process legal claims and appeals , and prepare records of hearings, investigations, courts-martial, and courts of ... inquiry. By joining the Army National Guard, you will be preparing yourself for a rewarding civilian career. In the civilian world, Paralegal Specialists may be referred to as legal assistants, clerks, paralegal assistants, and court clerks or recorders.… more
- Blanchard Valley Health System (Findlay, OH)
- …of productivity to effectively reduce days in A/R. Develops and writes appeals for denials associated with the payment of claims within the department/division. ... Maintains appropriate timeliness of appeals for denials. Identifies other means and resources to...A/R and payer issues, avoid timely claim consideration/filing, failed appeals , and/or increased denials & write-offs. Participates in and… more
- Accounting Now (Pinellas Park, FL)
- …companies on unpaid insurance accounts identified through aging reportsAble to identify an appeals worthy claim and or ability to process appeals online or ... insurance accounts identified through aging reportsAble to identify an appeals worthy claim and or ability to process ...appeals worthy claim and or ability to process appeals online or via paper submission; Assist with billing… more
- APN Consulting, Inc (TX)
- …cross-trained to work in a variety of areas and functions, including appeals , claims analytics, DRG Validation claims repricing, and outpatient payment integrity ... with coworkers, clients, members, providers and customers.Daily Responsibilities:Completing non-clinical appeals reviews for overpaid claims.Complete repricing of identified claims… more
- Spectraforce Technologies Inc (Columbia, SC)
- …and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following ... department guidelines. 40% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining… more
- Southeast Georgia Health System (Brunswick, GA)
- …a timely manner. Demonstrates proficiency in preparation and follow-up of denial appeals . Maintains denial spreadsheet report-keeps it current & accurate by payer. ... are conducted as outlined in the Utilization Plan. Coordinates patient's appeals to the Quality Improvement Organization (QIO) ensuring timely medical record… more
- Us Dermatology Partners (Tyler, TX)
- …fee schedules for commercial insurance and Medicare.* Oversee and evaluate insurance appeals process and results, revising as needed for ongoing efficiency and ... ensuring training on appeals for all Business Office staff.* Develop relationships with managed care companies and providers and with government payers.* Implement… more
- Penske Truck Leasing Co., LP (Reading, PA)
- …or manager with operating tax compliance processes including rendition/return filing, appeals and abatements and refund/bill entry. * Be able to understand ... or manager with operating tax compliance processes including rendition/return filing, appeals and abatements, bill entry for operating tax * Analyze processes,… more
- George Washington University (Washington, DC)
- …software. Logs, tracks, and segments donors and donations for future appeals . Continuously seeks opportunities for improvement in financial practices and internal ... controls and implements new policies and procedures where appropriate to safeguard the Center's funds. Ensures existing policies and procedures are followed while ensuring optimum levels of internal controls. Maintains current listings on GuideStar and… more
- US Tech Solutions, Inc. (Columbia, SC)
- …of professional, inpatient or outpatient, facility benefits or services, and appeals . Documents decisions using indicated protocol sets or clinical guidelines. ... Provides support and review of medical claims and utilization practices. May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination.… more
- Cambia Health Solutions, Inc (Renton, WA)
- …reviews)Understanding of claims, billing and codingFacets/claims systems in appeals , SIUClaims processing, claims configuration rolesUnderstanding of Medical and ... reimbursement policiesCPC Certified or willing to get CPC Certified as condition to position.Normally to be proficient in the competencies listed belowPolicy and Implementation Analyst would have a Bachelor's degree in Business Administration or a related… more
- Integrated Resources, Inc (Atlanta, GA)
- …Job Description: . Appeal Analyst RN who will train new hire in the clinical role to complete Utilization Management Appeals and act as an RN II on the team. ... Duration: 3 Months + possible extension… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- …provided in the hospital and office setting. Knowledge of the appeals processes for different payers.Knowledge of electronic billing systems and EMR'sAbility ... to work and resolve problems independently and demonstrate task completionDemonstrate thorough knowledge and understanding of CBO Policies and Procedures as well as the NGHS handbookDemonstrate thorough understanding of Medicare and commercial waivers if… more
- Compass Health Network (Union, MO)
- …in The Health Insurance Marketplace, MO HealthNet or CHIP.Assist persons with appeals and hearings related to Marketplace and MO HealthNet coverage issues.Complete ... all required trainings, participate in all meetings assigned, complete all required reporting.Provide referrals to any applicable office of health insurance consumer assistance or ombudsmanestablished under Section 2793 of the PHS Act to address consumer… more
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