Remote Appeals Technician for PBM & Health Claims
Judi Health
Judi Health is seeking a certified pharmacy technician to manage incoming requests for appeals in a remote role. Responsibilities include ensuring quality standards, communicating with pharmacists, and upholding HIPAA guidelines. Candidates must have at least one year of experience in a managed care or PBM setting and an active pharmacy technician license. The position allows for remote work with required hours from 12pm to 9pm EST. A strong emphasis on communication and organization skills is essential, with a competitive salary range based on location. #J-18808-Ljbffr
$60k - $65k
...About Judi Health Judi Health is an enterprise... ...management (PBM) solutions to self... ...consolidates all claim administration-related... ...level and external appeals while ensuring a... ...certified pharmacy technician in a managed care... ...stay productive in a remote, high-volume,...Remote workClaimsTemporary workLocal areaShift work- ...role focuses on resolving insurance claim denials for surgical specialty departments, generating appeals, and managing complex claims.... ...preferred. This position can be performed 100% remotely, and offers generous benefits including leave and health plans. #J-18808-Ljbffr...Remote workClaims
- ...Manager/Registered Nurse for Inpatient and Outpatient Clinical Appeals. This remote position requires 3+ years of nursing experience and... ...role involves managing provider appeals and performing post-claim analysis. The hospital offers a comprehensive benefits package...Remote workClaims
- A healthcare services firm based in the US is seeking a remote Medical Claim Review Nurse. In this role, you will conduct clinical reviews of... ...candidate will have a minimum of 3 years of experience in clinical appeals review and an active RN license. This full-time position...Remote workClaimsFull time
- ...Managed Resources, Inc. is seeking a part-time DRG Appeals Review Nurse to analyze denied MS-DRG and APR-DRG claims. This remote role requires a Registered Nurse (RN) license and expertise in clinical appeals and coding. The Nurse will be responsible for reviewing denials...Remote workClaimsPart time
- ...Appeals Specialist REMOTE - this position will be fully remote after training. Texas residents only Job Purpose The Appeals Specialist... ...is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence...Remote workClaimsWork experience placementWork at officeLocal area
- ...We are seeking a highly skilled Appeals Processor III (APP III) to join our dedicated team in a remote capacity. The Appeals Processor III (APP III) is responsible for... ...preferred) 2+ years in: Healthcare appeals Medical claims / utilization review Insurance or Medicaid/...Remote workClaimsContract work
- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity, developing...Remote workClaims
- ...Denials Appeals Specialist At Aspirion, our mission is simple and... ...receivable, motor vehicle accident claims, workers' compensation,... ...impact for the hospitals and health systems we serve. We are building... ...metrics-driven environment Remote work experience in a...Remote workClaimsPermanent employmentWork experience placement
$95k - $110k
...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions... ...trains to perform reviews of multiple claim types to provide a flexible workforce... ...401(k) employer match, comprehensive health benefits, and educational assistance....Remote workClaimsFull timeWork from homeRelocation packageFlexible hours$50k - $60k
...United States - Remote Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings... ...performance, open-access network alternative. As an Appeals Specialist – Workers’ Compensation, you will play...Remote workClaimsLocal areaFlexible hours$28.94 - $51.63 per hour
...UnitedHealthcare, we're simplifying the health care experience, creating healthier... ...You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you... ...Conducts reviews of member and provider appeals Analyzing claim adjustments and histories, and...Remote workClaimsHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to Friday- ...Right Place. Job Description: REMOTE POSITION!!! MUST HAVE HOME HEALTH & HOSPICE EXPERIENCE JOB SUMMARY: The Appeals Analyst performs medical record reviews... ...compliance. The incumbent analyzes submitted claims and/or claims to be submitted as well...Remote workClaimsWork experience placementWork at office
$21 - $23 per hour
...Description Job Description Job Title: Appeals Supervisor Location: Remote (U.S. – all states) Industry:... ...: This role is eligible for Health, Dental, Vision, 401K About Our... ...environment ~ Strong understanding of claims and appeals workflows (client will train...Remote workClaimsLocal areaImmediate start$25 per hour
...Lead Medical Records Technician – Outpatient (Remote) Location/Hours: Remote (VPN access), Monday–Friday,... ...Compensation: $25.00/hr plus $5.09 for Health and Wellness Role Summary Leads... ...related denials; coordinate with billing/claims teams. Assist supervisor with workload...Remote workClaimsMonday to Friday$246.1k - $344.2k
...relies on medical background and reviews health claims. You will work on problems of diverse... ...defensible medical decisions on complex appeal cases, exercising professional judgment... ...member PHI / HIPAA information This is a remote position anywhere in the USA #LI-...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipInterim roleWork at officeWork from homeHome officeMonday to Friday$91.7k - $163.7k
...our team will directly improve health outcomes by connecting people... ...enjoy the flexibility to work remotely from anywhere within the U.S.... ...~3+ years of experience in PBM Client Management or Client Support... ...~ Proficiency with RxClaim or Claims Adjudications Platforms ~...Remote workClaimsMinimum wageFull timeContract workWork experience placementLocal area$236.5k
...professional on our Medical Management/Health Services team. Centene is a... ...teams, network providers, appeals team, medical and pharmacy... ...and health care quality.Reviews claims involving complex, controversial... ...approach to work with remote, hybrid, field or office work...Remote workClaimsFull timePart timeWork at officeFlexible hoursWeekend work$29.7 - $31.8 per hour
...cycle management solutions for health systems, including hospitals... ...Position Summary The Acute Coding Appeals Specialist integrates medical... ..., spreadsheets, accounts, and claim examples of root cause issues.... ...and experiences This is a remote position; however, candidates...Remote workClaimsTemporary workWork at officeLocal area$22.84 - $32.89 per hour
...Included Health is hiring a Customer Service Representative to focus on managing health care claims. Successful candidates will have over 3 years of claims experience and excellent... .... It's a temp-to-hire position with a remote-first culture and competitive benefits and...Remote workClaimsTemporary work- ...business and we can accommodate a fully remote work arrangement depending upon location... ...and insureds. Review with underwriting technician risk profile and loss history... ...classified and priced. Discuss issues with Claims Department as needed. Approve underwriting...Remote workClaimsWork at officeNight shift
$80k - $100k
...Account Manager, PBM Charlotte, North Carolina, United States; Denver, Colorado... ...; New York, New York, United States; Remote About Judi Health Judi Health is an enterprise health... ...(EHP), which consolidates all claim administration-related workflows in one...Remote workClaimsWork at officeLocal areaFlexible hoursShift work- ...All Jobs Clinical Appeals Reviewer (Licensed Healthcare Professional... ...Professional) • Fully Remote • United States Full-time Description... ...solutions to federal agencies in health, agriculture, technology, and... ...with Medicare regulations, claims processing, and the medical review...Remote workClaimsFull timeContract workPart timeFor contractorsWork at officeLocal areaNight shift
$75k - $90k
...Judi Health is seeking a Benefit Operations Specialist to lead benefit configuration and claims testing for clients. This role focuses on ensuring accuracy and optimizing how integrated benefits are delivered in the healthcare sector. Candidates should have over 5 years...Remote workClaims- ...Knowtion Health is hiring for a remote position that involves analyzing denied claims, resolving account denials, and maintaining records of claims activities. Ideal candidates will have a minimum of 6 months of experience in hospital or healthcare billing settings, expertise...Remote workClaims
$88.85k
...Manager, Appeals and Grievances Job Category: Customer Service Department... ...in 1997, L.A. Care Health Plan is an independent public... ...Provider Network Operations, Claims, Utilization Management, Pharmacy... ...weekends, holidays, a hybrid remote schedule, occasional flexibility...Remote workClaimsFull timeFor contractorsShift workWeekend work$22.47 per hour
...Medical Records Technician (Remote) - Inpatient Medical Records Technician (Coder) – Inpatient Facility... ...30pm CT Client: Central Texas Veterans Health Care System (CTVHCS) – Temple, TX... ...assigned encounters. Collaborate with claims/billing staff on documentation and coding...Remote workClaimsFull timeContract workSeasonal workWork at officeMonday to Friday$58.62 - $90.48 per hour
...compliance guidance to Select Health leaders, with a primary focus... ...pharmacy benefit management (PBM) company. This position is accountable... ...This position is primarily remote with occasional need for... ...Medicare, Medicaid, HIPAA, False Claims Act, Anti-Kickback Statute, Stark...Remote workClaimsHourly payFull timeCurrently hiringLocal areaRelocationRelocation package- ...leading provider of Healthcare and Health Insurance services, seeks an accomplished Medical Appeals Coordinator Position: Medical... ...! Pay rate: $24/hr on W2 Note: REMOTE role with possibility The... ...working in grievances and appeals, claims, or customer service or any combination...Remote workClaimsTemporary workLocal areaFlexible hours3 days per week1 day per week
$19 - $29 per hour
...Indiana. This position involves conducting outpatient administrative claims coverage determinations while ensuring compliance with... ...role offers an hourly wage between $19-$29 and includes various health benefits from day one, along with opportunities for an annual bonus...Remote workClaimsHourly pay
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