Provider Appeals Specialist (Medicare/Medicaid)
Molina Healthcare of Illinois
Molina Healthcare in New York is seeking a Claims Support Specialist to assist with researching and resolving member and provider inquiries, including appeals and grievances, in alignment with CMS standards. You will review medical records, respond to inquiries, and document findings while ensuring timely processing of claims and adherence to state and federal guidelines. The role offers a competitive benefits package and opportunities to work within a regulated, patient-focused environment. #J-18808-Ljbffr Molina Healthcare
$16.4 - $31.97 per hour
JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing... ...established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties... ...comprehensive research and resolution of appeals, disputes, grievances, and/or complaints...SuggestedHourly payContract workWork experience placementWork at office$38.26k - $43.79k
Agency for Persons with Disabilities in Florida is hiring a PROVIDER ENROLLMENT COORDINATOR to join the team. This is not a Telework position... ...to an APD office in the area it serves. The role handles Medicaid Waiver provider application packets, reviews them for deficiencies...SuggestedWork at officeRemote work$14.9 - $29.06 per hour
JOB DESCRIPTION Provides entry level support for claims activities including reviewing and... ...established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties Enters denials and requests for appeals into information system and prepares documentation...SuggestedHourly payWork experience placementWork at office- ...Health Care Administration (AHCA) in Florida seeks an OPS Senior Human Services Program Specialist to deliver high-quality customer service in a fast-paced Medicaid recipient and provider assistance unit. The role focuses on answering questions, counseling on SMMC programs...Suggested
- A staffing firm is seeking a Provider Enrollment Representative responsible for the integrity of Medicare provider files. Applicants should have customer service experience and data entry skills. The role requires reviewing applications and ensuring compliance with regulations...SuggestedFull timeRemote work
- Doctors HealthCare Plans, Inc. is seeking a Provider Relations Representative in New York to manage provider orientations, site visits, and communications within the provider network. The role emphasizes CMS/AHCA guideline adherence, high-quality service, and bilingual...
- ...Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System... .... Through our select network of Medicare and Medicaid Certified and Accredited providers, we... ...program What Will You Be Doing The Intake Specialist is responsible for processing incoming...Temporary work
- ...healthcare revenue management company is seeking a Revenue Recovery Specialist to optimize revenue recovery by analyzing claim variances.... ...or managed care industries. You'll monitor payments, document appeals, and analyze processes to resolve issues. Join to help...Full time
- Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System in the home setting, offering Durable... ...and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to...Temporary work
- The Bilingual Medicaid Eligibility Advocate at HCA Florida Lawnwood Hospital helps screen patients for insurance coverage and government assistance, advising on benefits and co-pays. You will coordinate with the hospital, patients, and government agencies to manage eligibility...
$22.99 per hour
Job Description Summary The Program Specialist, Provider Education & Engagement supports the planning, coordination, and execution of provider education and engagement initiatives that advance Millennium's value-based care strategy. Assigned to one or more regions, this...- ...and safety rating from the Centers for Medicare & Medicaid Services (CMS). Education Graduate... ...Heart Association BLS for Health Care Provider Works independently with the ability... ...Nurse Position Summary The Breast Health Specialist nurse is responsible for the physical,...ReliefLocal area
- ...improvement in healthcare services. The ideal candidate has experience in managed care, excellent customer service skills, and knowledge of Medicaid policies. This position offers a competitive salary and benefits package, promoting a commitment to member satisfaction and...
- ...Overview Unifiedis a nationwide community of providers, operations specialists and thought leaders who look for the greatest opportunities to impact... ...Receivable and Collections, including Review, Follow Up, and Appeal denied claims according to standards Determine accuracy...Temporary workWork at officeFlexible hours
- ...kindness.” Job Summary The Revenue Cycle Specialist supports the daily operations of the... ...coordinating with coding teams to submit timely appeals, in order to recover revenue and... ...Performance Indicators (KPIs), in order to provide visibility on revenue performance to the...Contract work
$54.08k - $56.16k
...Exact Billing Solutions provided pay range This range is provided by Exact Billing Solutions... ....00/yr - $56,160.00/yr Revenue Recovery Specialist - Exact Billing Solutions (EBS)... ...responsible for monitoring, analyzing, and appealing outpatient‑based claim payment variances...Hourly payWork at officeFlexible hours- ...Position: A/R Specialist The A/R Specialist is responsible for the company... ...Care Organization (MCO), Medicare, Other Federal, Private... ...information on pending claims Sends appeal letters to insurance Obtains... ...charge entry/billing errors Provides proper documentation to insurance...Permanent employmentTemporary workWork at office
- ...and Families Working Title: ELIGIBILITY SPECIALIST I - 60069056 Position Number:60069056 Salary... ...for others, in need of assistance to provide shelter for loved ones, or just need a... ...determine eligibility for Food Assistance, Medicaid, and Cash Assistance. Learning numerous...Work at officeLocal areaRemote workMonday to FridayFlexible hours
$45.39k - $88.51k
...Job Summary Provides senior level support for government contracts activities. Responsible for the development and administration of contracts with state and/or federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide...Contract workWork experience placementWork at office- ...insurances, monitoring account activity and providing adequate follow up to ensure maximum... ...that all denied claims are corrected or appealed, and provide appropriate feedback to management... ...(EOBs) Knowledge of Medical Assistance, Medicare PartBand commercial insurance products...Work at office
- Working Title: Eligibility Specialist I - 60044953 Salary: $1,392.96 bi-weekly, $36,216.96... ...determine eligibility for Food Assistance, Medicaid, and Cash Assistance Learn and apply... ...computer‑based system Research information provided by applicants to confirm eligibility...Remote work
$14.9 - $29.06 per hour
...issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the... .../ Skills / Abilities Maintains confidential telephone line to provide direct assistance to Members and/or family members who are...Hourly payWork experience placement- Position Summary The Medicare Retention Specialist is responsible for supporting member retention efforts by providing exceptional customer service to Medicare Advantage members. This role focuses on addressing member concerns, resolving issues, and educating members on...Work at officeMonday to Friday
$19.76 - $36.75 per hour
...State Florida Postal Code 32751 Job Description Reviews and appeals denials across all service lines system-wide Researches account... ..., and clinical departments to gather supporting documentation Provides reports, education, and training on denial trends and...Full timeWork experience placementLocal areaShift work- ...today! Job Details The Field Reimbursement Specialist (FRS) serves as a subject‑matter expert... ...medications by educating healthcare providers and their staff on complex insurance and... ...billing, formulary, prior authorization, and appeal processes. Probe to understand office...Work at officeLocal areaNight shift
$26 - $27 per hour
Revenue Recovery Specialist - Exact Billing Solutions (EBS) | Lauderdale Lakes, FL Salary... ...responsible for monitoring, analyzing, and appealing outpatient‑based claim payment... ...integrity, and client focus, we empower providers to thrive while making the business of...Hourly payFull timeWork at officeFlexible hours- ...collection of accounts receivable, monitoring account activity, and providing appropriate follow-up to maximize reimbursement for ancillary... ...Perform collection activities, including status calls, appeals, and account reviews to ensure timely reimbursement. Research and...Work at officeShift work
- ...in Maitland, FL is seeking a Denials Management Specialist to support the Revenue Cycle team. You will review and appeal denials across service lines, research payer... ...Epic EHR. Training and ongoing development are provided in a healthcare environment. #J-18808-Ljbffr AdventHealth
- ...and Families Working Title: ELIGIBILITY SPECIALIST I - 60049559 Position Number: 60049559... ...determine eligibility for Food Assistance, Medicaid, and Cash Assistance. Learn numerous... ...current regulations. Research information provided by an applicant until eligibility status...Remote workMonday to Friday
$31.13 per hour
Reimbursement Specialist - Contract Opportunity Location: Sarasota, FL Contract... ...activities and follow up with insurance providers Accurately document account... ...billing experience Experience with Medicare Part A Experience with Medicaid, Managed Care/Insurance, and Private...Contract workWork at office
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