- 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
- 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
- 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
- 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
- Preferred Solutions Group (Bethesda, MD)
- …the appropriateness of the release and review and make recommendations regarding appeals . . Review documents and responses to ensure compliance with the Acts ... Counsel in reviewing and arriving at recommendations regarding requests involving administrative appeals . . Review appeals for non-release of information or fees… more
- Option Care Health (Columbus, OH)
- …with Billing and Collection Training and completes "second level" appeals to payers.Job Description: Job Responsibilities:Submits timely, accurate invoices to ... payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized… 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
- Mindlance (Columbia, SC)
- …as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following organizational ... department guidelines. *45% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining… more
- US Tech Solutions, Inc. (Columbia, SC)
- …as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following organizational ... department guidelines. . Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining… 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
- US Tech Solutions, Inc. (Atlanta, GA)
- …and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance ... resolve coverage requests. . Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance… 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
- US Tech Solutions, Inc. (Atlanta, GA)
- …other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). . Identify and elevate clinical inquiries to the pharmacist ... team as appropriate . Other duties assigned, for example faxes, sorting, email boxes, CAS maintenance, etc. Experience: . 0 to 3 years of related work experience. Skills: . Prior Authorization . Call handling experience. Education: . High School diploma or GED… 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
- Valmont Industries, Inc. (Miami Shores, FL)
- …respond to agency audit request, complaint investigation/resolution measures, unemployment claims & appeals (OSHA, EEC, DOL, OFCCP, DFEH, etc.)Must keep up to date ... and have general understanding of legal requirements and government reporting regulations affecting the human resources function Other Important Details about the Role:Champion HR-related initiatives and notifies employees of new company policies 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
- On Call Counsel (New York, NY)
- …settlement of special education claims.Prepare and argue difficult cases and appeals in administrative tribunals.Review, revise, and approve agreements prepared by ... other attorneys.Draft memoranda seeking fiscal settlement authority.Analyze the relative strength of impartial hearing cases and evaluate the appropriateness of plaintiffs' demands.Instruct appropriate offices regarding their obligations to parents and… more
- CornerStone Staffing (Dallas, TX)
- …the names of speakers and any technical terminology. Prepare transcripts for appeals or other future legal proceedings. Serve as liaison to lawyers, judges, ... or other local officials; providing information relating to court hearings and charges. Manage the commissions and creation of certificates of proceedings. Accept ownership for accomplishing new and different requests; explore opportunities to add value to job… more
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