- 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
- Universal Health Services (Reno, NV)
- …Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, ... of Universal Health Services (UHS). We offer HMO, PPO, and Medicare Advantage plans, Administrative Services for self-funded organizations, and Accountable Care… 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered...in a manner consistent with LA Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit… 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
- Molina Healthcare (NM)
- …of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… 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
- Randstad US (Dallas, TX)
- medical appeals and denials specialist . + dallas , texas + posted april 30, 2024 **job details** summary + $20 - $20.93 per hour + temp to perm + high school + ... further. Must have at least 2 years of backend appeals and denials experience. salary: $20 - $20.93 per...per day. Knowledgeable with payors including Managed Care, Commercial, Medicare , and Medicaid .Knowledge of CPT codes, Modifiers .Knowledge… 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
- Medical Mutual of Ohio (OH)
- …of education/training and experience. . 7 years progressive experience as an Appeals /Customer Resolution Specialist or equivalent experience in customer service ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Supervises operations and… more
- Elderwood (Buffalo, NY)
- …Medical Billing Specialist to join our team. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Elderwood Administrative Services is ... Life Insurance, Medical, Dental, and Vision insurance Responsibilities Medical Billing Specialist ( Medicare /Managed Care): + Review remittances for potential… 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
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Offices of Hearings and Inquiries (OHI), Marketplace ... Appeals Group (MAG), Division of Hearings (DOH). As a Health Insurance Specialist , GS-0107-13, you will apply comprehensive knowledge and skill in reviewing and… more
- MD Anderson Cancer Center (Houston, TX)
- …of the PBS Billing Specialist position is to bill and follow-up on Medicare claims within regulatory guidelines. The PBS Billing Specialist must ensure that ... via Medicare FSS terminal 4. Complete daily response & rejection reports 5. Process appeals 6. Work Medicare denials 7. Required to stay abreast of all … 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
- The Wesley Community (Saratoga Springs, NY)
- Medical Billing Specialist Full Time | Day Shift | 8am-4:30pm ** Pay rate $ 20-23 /hour ** The Wesley Community is no longer requiring employees to be vaccinated for ... heart. What will I do as a Medical Billing Specialist for The Wesley Community? + Process mail and...+ Prepare and produce all Wesley primary billing for Medicare , HMO, VA, MLTC as well as secondary Medicaid… more
- TEKsystems (Waco, 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
- Robert Half Accountemps (Cincinnati, OH)
- …offering a contract to hire employment opportunity for a Medical Billing Specialist in the Healthcare industry, based in CINCINNATI, Ohio. The successful candidate ... Excel to maintain accurate records and perform billing functions. * Manage appeals process with insurance companies over any payment discrepancies. * Oversee the… 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