Remote Appeals & Disputes Specialist
S&S Healthcare
Cincinnati, OH
- Remote job
Reflect Health, an independent administrator, seeks an Appeals & Disputes Specialist for remote work. You will review, investigate, and resolve member appeals and provider disputes, ensuring accurate, timely determinations in line with plan documents and regulations. The role requires experience with medical claims processing, CPT/ICD-10/HCPCS coding, ERISA, ACA, CMS rules, and strong analytical and communication skills. #J-18808-Ljbffr S&S Healthcare
Vacancy posted 23 hours ago
Similar jobs that could be interesting for youBased on the Remote Appeals & Disputes Specialist in Cincinnati, OH vacancy
$50k - $60k
...funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members. The Appeals & Disputes Specialist is responsible for reviewing, investigating, and resolving member appeals and provider disputes for benefit plans,...Remote workFull timeWork at office- Reflect Health is seeking an Appeals & Disputes Specialist to review, investigate, and resolve member appeals and provider disputes with a focus on compliant and timely determinations. This remote role supports plan interpretation, coding review, and collaboration with...Remote job
- Sanderson Firm, a women-owned MSP compliance specialist, seeks a Medicare Coding Specialist to research, dispute, and finalize reimbursement obligations for clients... ...legal reasoning to support dispute strategies. This remote-friendly role requires strong analytical skills,...Remote jobFor contractors
- ...Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements while working remotely. Key responsibilities Perform data entry to track...Remote workFull timeVisa sponsorshipWork visa
Virtual Vocations Inc
United States1 day ago - ...Centers for Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or...Remote workFull timeContract workWork at office
$60.78k
...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances Location... ..., and complex provider claim disputes. The position is further responsible... ...hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workFull timeLocal areaShift workWeekend workLOS Angeles Care Health Plan
Los Angeles, CA9 hours ago- Banner Plans & Networks in Arizona seeks a Grievance and Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes in a remote setting. Candidates must reside in Arizona; you will document findings...Remote job
- Appeals Specialist (LPN, RN, or Therapist) Location: Massachusetts (RegalCare Facility network / Hybrid-Remote options available) Position Type: Full-Time Role Overview RegalCare is seeking... ...rejections, and managed care disputes. Gather clinical evidence and draft comprehensive...Remote workFull time
- ...Centers for Medicare and Medicaid Services (CMS). Essential Job Duties Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory...Remote jobContract workWork at office
- ...excellent work-life balance. For most jobs, remote work is available for 9 out of every 10 workdays. Job Description The Appeals Specialist I position plays a critical role ensuring... ...Review Committee and the PEHP Provider Dispute Review Committee. This role performs a...Remote workWork at office
- Job Category Appeals, Grievances, Specialist Employee Type Exempt - FT Manage Others No Contact information... ...grievances, and appeals. This fully remote position focuses primarily on... ...Harbor Health departments to evaluate disputed issues and ensure appropriate adjudication...Remote workHome office
- ...Job Description Job Description Description: 100% REMOTE CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 15 STATES (Client... ...Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Client members, providers...Remote workContract workLive inMonday to Friday
Integrated Resources, Inc
Dallas, TX18 days ago - ...Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve... ..., and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone. Required: high...Remote work
Acentra Health, LLC
Salem, OR1 day ago - ...Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings... ...strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or...Remote work
Network Health
Menasha, WI3 days ago - ...Partner Company is a healthcare organization focused on pediatric care and research, seeking a specialist to manage denial and appeal follow-up within a fully remote team. The role requires working with revenue integrity teams and leveraging tracking systems to monitor...Remote work
Partner Engineering and Science
New York, NY1 day ago $56.27k - $69.9k
Pay Plan Title: Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location: Remote within North Carolina POSTING DETAILS: Make an Impact Trillium Health Resources is...Remote workFull timeWork at officeLocal areaImmediate startWork from homeFlexible hours- ...University Physicians is seeking a Revenue Recovery Specialist to analyze denials, prepare reconsiderations, and file appeals to improve revenue recovery. The role requires... ...patient accounts, with opportunities to work remotely under the university's work-from-home program....Remote jobWork from home
- ...To support the review process of claims, the full-time Senior Appeals Specialist will conduct thorough appeals reviews of terminated or denied Short Term Disability, Long Term Disability, and Life claims, while adhering to regulatory guidelines and collaborating with...Remote workFull timeTemporary workWork experience placement
Virtual Vocations Inc
United States3 days ago - ...Leveraging expertise in claims adjudication and risk management, the full-time remote Appeals Specialist will guide clients through the appeals process, ensuring compliance and fair decisions while collaborating with internal teams and mentoring staff. Key responsibilities...Remote workFull timeContract work
Virtual Vocations Inc
United States4 days ago $19.13 - $34.17 per hour
...Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal,... ...And Mentor Less Experienced Appeals Specialists. JOB REQUIREMENTS: * High School... ...plan. This position may be performed remotely from anywhere within the continental United...Remote workHealth Care Service Corporation
United States2 days ago$29.7 - $31.8 per hour
## Acute Coding Appeals SpecialistApply: Remote - Nationwide: Full time: Posted Today: R052289**Thank you for considering a career at Ensemble!*... ...70 - $31.80 based on experienceThe Acute Coding Appeals Specialist integrates medical coding principles and objectivity in...Remote workFull timeTemporary workWork at officeLocal areaEnsemble Health Partners
Eastern, KY4 days ago- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
Health First
United States1 day ago - Position Summary The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department... ...extended sitting and computer work. WORK ENVIRONMENT Remote Here at Allied, we believe that great talent can thrive from...Remote workWork experience placementWork from home
- Mosaic Life Care is seeking a CDI Nurse Specialist to support clinical documentation integrity across our care teams. You will review, query and appeal to ensure accurate coding and appropriate DRG assignments, collaborating with physicians and coders. The role emphasizes...Remote job
- ...Documentation Improvement focus to perform CDI reviews, coding, and denial appeals. The role requires collaboration with physicians, managers, and... ...and coding for patient cases. The position supports remote work for qualifying states, including Nebraska, with...Remote job
- Brown University Health is seeking a Denials Management Specialist in Rhode Island. The role focuses on maximizing reimbursement by analyzing... ...initiatives related to denials reduction. You will handle appeals with third-party payers, coordinate with hospital departments,...Remote job
- Humana, Inc. seeks a Grievances & Appeals Representative 2 to manage denials and concerns by conducting analytic review of clinical documentation and delivering final determinations in coordination with clinical partners. The role supports members and providers by addressing...Remote job
- The University of Texas Southwestern Medical Center is seeking a Technical Denials Management Specialist II to review, research, and resolve claim denials and appeals for various insurers. The role emphasizes follow-up and resolution of denied claims, with no direct billing...Remote job
- Washington University in St. Louis is seeking a remote Medical Coding Specialist responsible for advanced coding, payer appeal tasks, and timely filing of insurance appeals. You will review records to select CPT and ICD-10 codes, collaborate with physicians, and lead coding...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Appeals & Disputes Specialist. Be the first to apply!
Related searches
- patient safety specialist Cincinnati, OH
- credit card specialist Cincinnati, OH
- senior specialist Cincinnati, OH
- health program specialist Cincinnati, OH
- youth specialist Cincinnati, OH
- microsoft specialist Cincinnati, OH
- transportation specialist Cincinnati, OH
- color specialist Cincinnati, OH
- hearing specialist Cincinnati, OH
- crisis specialist Cincinnati, OH