Appeals Specialist - Non-Medical Reviews & Docs
Southcarolinablues
BlueCross BlueShield of South Carolina’s CGS Administrators is seeking detail-oriented professionals to join our team in Nashville. This onsite/remote role supports non-medical claims reviews, redetermination letters, and department document updates as part of Medicaid-related operations. You'll analyze workload, prepare unit reports, and collaborate across systems using Microsoft Office. Required: high school diploma, 2 years related experience, strong writing and communication skills, and #J-18808-Ljbffr Southcarolinablues
$39.4 - $53 per hour
...seeking Virtual Utilization Review Specialists to join our team. Resource Utilization... ...to third party payers Medical Necessity Determination... ...documentation relevant to the appeal process Maintains appropriate... ...patient communication regarding non-coverage of benefits Maintains...MedicalTemporary workWork at officeLocal areaRemote workMonday to FridayWeekend work- ...beneficiaries, healthcare providers, and medical equipment suppliers for more than 50... ...time employment. What You’ll Do Performs non-medical reviews and processes redetermination letters... ...Experience in medical claims processing, appeals, or coding strongly preferred. Medicare...MedicalFull timeContract workFor contractorsWork experience placementSecond jobWork at officeLocal areaRemote workShift work
$29.7 - $31.8 per hour
...0 based on experience Job Description The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of... ...supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for inpatient Diagnosis Related...MedicalTemporary workWork at officeLocal areaRemote work- Join TriHealth as a Coding Appeals Specialist - Hospital Billing! TriHealth offers Coding Denials... ...comprehensive benefits package - including medical, dental, vision, paid time off,... ...which include, following up on denials, review of charts and coding issues. Backs up for...MedicalFull timeDay shift
- ## Non-QM Income Scenario Specialist (Wholesale)Applyremote type: Remotelocations: Remote USAtime type: Full... ...robust benefits package, including medical, dental, vision, as well as a 401K.... ...for providing income calculations and reviews for loans prior to underwriter...MedicalTemporary workSelf employmentRemote work
- ## Non-Agency Scenario Desk SpecialistApplyremote type: Remotelocations... ...benefits package, including medical, dental, vision, as well as a... ...The Non-Agency Scenario Desk Specialist is responsible for providing... ...specific guidelines, reviewing and analyzing income scenarios...MedicalTemporary workRemote work
- ...contribute How you’ll contribute Utilization Review Specialist facilitates clinical reviews on all... ...requirements are met. Ensure appeals are completed thoroughly and on a timely... ...this position also offers: Comprehensive medical, dental, and vision plans, plus flexible...MedicalTemporary workFlexible hours
$110k
...appropriate documentation for justification. Reviews the patient’s plan of care in conjunction... ...hospital. 8. Documents level of care and medical necessity in the Care Management database... ...on insurance denials and assists in appeal process. Qualifications Bachelor Degree Preferred...MedicalDaily paidFull timePart timeFlexible hoursShift work- All Jobs > Charge Review/Entry Specialist The Charge Review / Charge Entry Specialist is responsible for accurately reviewing and entering patient... ...capture, or revenue cycle operations (clinic, hospital, or medical billing company environment). Working knowledge of medical...MedicalWork at office
- Centene is seeking a Grievance and Appeals Coordinator I to join our Medical Management/Health Services team. This remote role requires residing in Arizona and involves analyzing and resolving verbal and written claims, appeals from providers, and pursuing resolution of...MedicalRemote job
- ...Type: Full-Time, Hourly, Non-Exempt About Wantable... ...Apparel Production QC Specialist who combines strong apparel... ...early, conducting and reviewing quality inspections,... ...Workspace (Drive, Gmail, Docs, and Sheets). Physical... ...parking, we offer medical (traditional and high deductible...MedicalHourly payFull timeFor contractorsCasual workWork at officeLocal areaImmediate startFlexible hours
$20 - $36 per hour
...Reimbursement Pharmacy Specialist will be responsible... ...prior authorizations and appeals. The role also... ...process for prescriptions medications Navigate calls to pharmacy... ...public, private, and non-profit organizations... ...portfolio Responsible for reviewing, interpreting, and...MedicalHourly payMinimum wageFull timeTemporary workWork experience placementLocal areaRemote workMonday to FridayShift work$23.75 - $39.62 per hour
...well. Job Title Lending Specialist Expected Work Hours 40... ...closings. Coordinate and review closing documentation (... ...counsel or internal doc prep) and information with... ...-time Full-time FLSA Non-exempt Total Rewards Summary... .../E-Verify Family and Medical Leave Act Employer...MedicalFull timePart timeWork at office- ...and/or drug abuse in residential and/or non-residential programs. Functions as the team... ...others.Interviews residents/consumers, reviews records, makes appropriate entries in residents... ...support services as needed, such as medical evaluation and treatment, social services...MedicalFull timeImmediate start
$19.18 - $30.14 per hour
...Recovery Specialist Associate - Call Center Anticipated End Date: 08... ...subrogation files. Identifies, reviews, sets up or closes health... ...experience strongly preferred. Medical claims processing experience... ...based on a number of legitimate, non-discriminatory factors set by...MedicalTemporary workWork experience placementWork at officeLocal areaMonday to FridayShift work2 days per week1 day per week- ...Job Title: A/R Specialist Department: Revenue Cycle Management Reports... ...to: A/R Manager FLSA Status: Non-Exempt Dental Account... ...receivable, prioritizing account reviews and utilizing time management... ...Positions (30-35 hours per week): Medical Insurance : Choice of five...MedicalFull timeContract workTemporary workPart timeWork at officeRemote workFlexible hours
- ...Position overview: The Coding Specialist I is responsible for independently reviewing, analyzing, and resolving all... ...professional fee environment. Reviews medical records and all applicable... ...lift and move up to 30 pounds on a non-routine basis. Ability to sit...MedicalHourly payWork at officeLocal area
$20.98 - $30.12 per hour
Company Description The University of Maryland Medical System (UMMS) is an academic private... ...insurers to recover inaccurate payments. Reviews accounts to ensure accuracy of billing/... ...information and professionalism. Performs appeals process when appropriate. Promotes accuracy...MedicalImmediate startRemote work- ...67, USA Industrial Prevention Specialist – ProgressiveHealth, LLC – Smyrna... ...and/or escalation of medical care if needed Providing ergonomic... ...company reserves the right to review and modify the functions, duties... ...spectrum of occupational and non-occupational health services including...MedicalFull timeH1bWork at officeWork visaShift workNight shiftDay shift
- ## HIM CDI Specialist, RemoteApplylocations: Ambulatory Care Building - UMCtime type: Full... ...**This position is responsible for reviewing patient medical records to facilitate modifications to... ...clinical disease classifications, major and non-major complications and comorbidities...MedicalRemote workShift workDay shift
- ...General Summary The Distribution Specialist provides comprehensive inventory support including linens, medical and housekeeping supplies, and... ...definition of essential and non-essential job functions.)... ...assigned by Human Resources upon review of the Principal Job Functions...Medical
$19.32 - $24.13 per hour
...primary and specialty care. Capital Health Medical Group is made up of more than600... ...including but not limited to pre and post claim review, claim (277) rejections, denial review,... ...g. authorizations, medical records) for appealing denials. Works correspondence as...MedicalFull timeTemporary workPart timeWork at officeFlexible hours$44k
...Job Profile: Academic Program Specialist Job Summary: The Department... ...recognized faculty, innovative medical education programs and... ...3,888 annually be considered non-exempt under FLSA provisions... ...qualifications listed above. Application reviewers will rely on these written...MedicalHourly payOngoing contractPermanent employmentFull timePart timeImmediate start$64.35k
...Behavior Intervention Specialist Under supervision of BIS leadership... ..., social, physical, medical/psychiatric conditions that may... ...modifications, false reporting, non-reversible medical diagnosis.... ...interdisciplinary meetings and case reviews, including scheduled Person-...MedicalFull timeReliefMonday to FridayFlexible hoursAfternoon shift- ...dynamic Construction Technology Specialist that will be based in our Salt... ...a highly technical nature to non-technical customers Excellent... ...vendor contacts BENEFITS: 100% Medical & Dental premiums paid for... ...For further information, please review the Know Your Rights notice from...MedicalFull timeWork at office
$8,014 per month
...Team as a Facilities Control Specialist! Are you an expert in building... ...This position is designated non-exempt under FLSA and is eligible... ...the UC. Health Coverage : Medical, dental, and vision options... ...submitted after this date will be reviewed on an as-needed basis, and...MedicalPermanent employmentFull timeContract workWork experience placementH1bLocal areaRemote workMonday to Friday$20 per hour
...Function: || The Certified Coding Specialist (CCS) is responsible for... ...compliant coding, charge capture review, claims support, and... ...to ensure coding accuracy and medical necessity. Identify coding discrepancies... ...with denial management and appeals related to coding issues....MedicalFull timeWork experience placementWork at officeImmediate startMonday to FridayShift workWeekend workDay shift- ...Position Title:Grants Finance Specialist## Job Group:Professional &... ...expenditures to resolve issues of non-compliance or lack of funds•... ...line requests• Provides and reviews sponsored funding financial reports... ...-life benefits, including medical and dental, as well as:*...MedicalFull timeWork at officeRemote workFlexible hours
$18.65 - $19.9 per hour
...VA. The Senior Patient Access Specialist is responsible for performing... ...accurate MRNs, completing medical necessity or compliance checks... ...implemented for future services. Reviews eligibility responses in... ...Medicare patients of possible non-payment of test by Medicare and...MedicalWork at officeLocal areaRemote work$23 - $27 per hour
...purpose. MeBe is seeking a Revenue Cycle Specialist specializing in ABA - Applied... ...Submit claims, processes follow-up on payer appeals, and will communicate with manager on status... ...in a timely fashion. When necessary, reviews medical records and resubmits claims with appropriate...MedicalHourly payPermanent employmentTemporary workLocal area
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