- Jazz Pharmaceuticals (New York, NY)
- …and ensure providers understand payer prior authorization requirements, appeals process, clinical criteria, and appropriate coding information.Demonstrate deep ... or similar coding certification preferred, not requiredPrior Authorization Certification Specialist (PACS) preferred, not requiredJazz Pharmaceuticals is an equal… more
- Martin's Point Health Care (Portland, ME)
- …Place to Work" since 2015. Position Summary Job Description Position Summary: The Appeals Specialist (Medicare or US Family Health Plan) is responsible for ... in accordance with CMS requirements + Cross-trains with US Family Health Plan Appeals Specialist to perform functions as needed US Family Health Plan Focus Key… more
- Universal Health Services (Richmond, VA)
- …The Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist . The Senior Appeals Specialist ... identified during the billing of claims and the follow-up on the clinical appeals performed by the facilities. Key Responsibilities include: + Responsible for higher… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as an Appeals Specialist ? At Parallon, you come first. HCA Healthcare has committed up ... have the opportunity to make a difference. We are looking for a dedicated Appeals Specialist like you to be a part of our team. **Job Summary and… more
- Universal Health Services (Richmond, VA)
- …Rico and the United Kingdom. The Atlantic Region CBO is seeking a dynamic and talented Appeals Specialist . The Appeals Specialist is responsible for the ... identified during the billing of claims and the follow-up on the clinical appeals performed by the facilities. Key Responsibilities include: + Responsible for … more
- MCG Health System (Augusta, GA)
- Denials and Appeals Specialist Work Location: Satellite Location Req Number: 35021 Department Name: Prof Rev Cycle Svcs Shift: Days/No Weekends Position Status: ... the Search Results or Job Cart. Position Description The Denials and Appeals Specialist is responsible for timely and accurate resolution of denied insurance… 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 ... location in **Plano, TX** currently has an opportunity for a **Sr. Appeals Specialist ** . This role is responsible for facilitating and assisting Abbott patients… 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 ... in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety of… more
- Alight (TX)
- …of Be Alight. Learn more at careers.alight.com. **About the Role** The Appeals Specialist reviews adverse determination outcomes for Short Term Disability ... **Do you want to be part of a collaborative Appeals team?** **Our Story** At Alight, we believe a...are in dispute. Handling assigned case load of claim appeals . . Evaluating essential information and consulting with stakeholders… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after ... physician-to-physician (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial outcomes with assistance from appeals team, identifies… 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
- Generac Power Systems (Waukesha, WI)
- ** Appeals & Grievances Specialist I** **Company** Generac Power Systems **Name** Appeals & Grievances Specialist I **Req #** 64663 **Employment Type** ... and enjoy a fast-paced, high-performance culture. **Job Summary:** The Appeals and Grievances Specialist is a critical team player who is responsible for… more
- ManpowerGroup (Columbia, SC)
- Job Tittle: Appeals Specialist Location: Columbia, SC Duration: 6+ Months Pay Rate: $17/hr We are looking for an Appeals Specialist (Data entry) to join ... one of our Fortune 500 Healthcare clients. **Job Description** + Performs non-medical reviews and processes redetermination letters. + 50% Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy. + 30% Prepares unit… 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Scripps Health (San Diego, CA)
- …**Job:** **Business Office* **Organization:** **Scripps Health Corp* **Title:** *Public Resource Specialist - Programs & Appeals * **Location:** *Central San ... at our Scripps Corporate Office as a Public Resource Specialist . In this position, you will be responsible for...of the applications, through to the highest level of appeals while adhering to all policies on fraud/abuse and… 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...Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training… more
- University of Virginia (Charlottesville, VA)
- …+ Works complex denials with a high degree of accuracy and timeliness. Responds to inquiries from patients, clinical departments, and third parties by way of ... telephone, written correspondence and personal contacts. + Adds/corrects registration, insurance, and demographic data in the EPIC billing system to ensure accurate records. + Analyzes and prepares applicable adjustments to physicians' fees in compliance with… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and… more
- Sanford Health (Sioux Falls, SD)
- …interpretation of policies, and handling of correspondence related to denials and appeals submitted by providers and members. Must administer benefits in accordance ... demonstrated understanding of regulatory requirements and timeframes. Intake and coordinate appeals and denials, and then make determinations based on member policy… more
- Internal Revenue Service (Fresno, CA)
- …CAREERS? Visit us on the web at www.jobs.irs.gov Responsibilities WHAT IS THE APPEALS DIVISION? A description of the business units can be found at: ... Vacancies will be filled in the following specialty areas: Office of Appeals Case and Operations Support Account and Processing Support Special Programs AARS… more
