Remote Prior Authorization Appeals Specialist
OpenKrill
- Remote job
IVX Health is seeking a Prior Authorization Appeals Specialist to resolve complex pre-service denials and appeals. You will work with providers, payers, and internal teams to navigate payer requirements and assemble supporting documentation for timely reconsiderations. The role emphasizes experience with prior authorization, denial management, and collaboration in a remote setting, ensuring accurate clinical documentation and streamlined processes. #J-18808-Ljbffr OpenKrill
- ...provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and... ...Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members,...Remote workFull timeContract workWork at office
$22.99 per hour
...experienced claims or healthcare appeals professional looking for a rewarding, fully remote opportunity? We are seeking a dedicated Appeals Specialist to join our collaborative team!... ...appropriate resolutions, modify prior authorizations, and respond to claims and utilization...Remote workHourly payPermanent employmentContract workTemporary workWork experience placementHome officeShift work$26 per hour
...Responsibilities The Authorization Representative will need to cover... ...of authorization status. Prior Authorization and Eligibility... ...reimbursement. Denials and Appeals Review authorization-... ...for this role is: 26 - 26 USD per hour (Remote (United States))Remote workHourly pay- ...Managing the full life cycle of member and provider appeals and grievance cases, the full-time Appeals and Grievance Specialist will conduct case intake, investigation, and... ...to ensure timely resolution while working remotely. Key responsibilities Research and analyze case...Remote workFull timeWork at office
- ...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
- ...seeking a Denials Management Follow Up Representative for a fully remote, full-time position in the United States. You will coordinate... ...for institutional and professional claims, monitor appeals, and analyze performance data to drive improvements. Work closely...Remote workFull time
- ...Coding Specialist Full-Time (80 hours a pay period) | Revenue Integrity... ...Work Arrangement: Hybrid/Remote options available following... ..., clinical departments, and Prior Authorization teams to resolve... ...expertise for claim corrections, appeals, denial reviews, and reimbursement...Remote workFull timeTemporary workMonday to Friday
- ...full-time Revenue Cycle Management Specialist will manage payer authorizations, claim submissions, and resolution... ...Responsibilities Obtain and validate prior authorizations and verify member... ...determine appropriate actions and work on appeals and A/R follow-up Required...Remote workFull time
- ...the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes,... ...NCQA requirements while working remotely. Key responsibilities Perform data... ...Dispute Resolution (IDR) preferred Authorization to work in the U.S. without the...Remote workFull timeVisa sponsorshipWork visa
$48.32k - $82.39k
...investigating and tracking member grievances and appeals, and provider claims disputes.... ...and interpretation of appropriate legal authorities/policies. ~ Write investigative reports... ..., and a flexible approach to work with remote, hybrid, field or office work schedules....Remote workHourly payFull timePart timeWork at officeFlexible hours$13 per hour
...Pride Health is hiring a Prior Authorization Specialist to support our client's healthcare facility in... ...EST Location: Sumter, SC 29150 or Remote Job Type: Contract Contract Length... ...denial determinations and coordinate appeals when appropriate. Maintain...Remote workContract workLocal area$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances... ...This position reviews pre-service authorizations, concurrent and post-service (... ...hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workFull timeLocal areaShift workWeekend work$52k - $79.04k
...Appeals Specialist | Tyson & Mendes Are you a detail-oriented billing professional who enjoys solving problems, navigating complex billing... ...policies, please refer to the document provided here . No recruiters/agencies #li-remote Pay Range $25—$38 USD...Remote workHourly payFull timeWork at office$24 - $28 per hour
...position to start Future hybrid or remote opportunities may be available based... ...organization is seeking experienced Prior Authorization Specialists to join its team in Sandy, Utah .... ...requests Assist with denials, appeals, and coverage issues Maintain...Remote workSecond jobWork at officeImmediate startMonday to Friday- ...Description: Role Summary: The Authorization Specialist role is responsible for all... ...and or medically necessary appeals. Review payer guidelines... ...including frequency and prior testing requirements.... ...may vary based on the needs of the organization. #LI-REMOTE...Remote workFull timeWork at office
- ...The Benefits Verification Specialist is responsible for conducting... ...flexibility in the shift. Remote Work Requirements: Candidates... ..., and submit and obtain prior authorizations as required by payer;... ..., prior authorizations and appeals preferred. Benefits: At...Remote workContract workTemporary workFixed term contractLocal areaMonday to FridayFlexible hoursShift work
- ...Submits, tracks, and manages prior authorization requests for medical and ancillary procedures,... ...providers, and insurance payers to file appeals or facilitate a P2P. Reviews patient... ...previous experience as a Prior Authorization Specialist, with expertise in medical billing,...Remote workWork at office
$29.7 - $31.8 per hour
...based on experience. The Acute Coding Appeals Specialist integrates medical coding principles... ...and client experiences. This is a remote position; however, candidates must be... ...limited to individuals who reside and are authorized to work within the United States....Remote workTemporary workWork at officeLocal area$20 per hour
...Role Snapshot The Intake Specialist manages inbound and outbound... ...cases. This role supports prior authorizations, claims processing including... ...consideration, we do offer remote work in the following approved... ...Process claims and support appeals and authorization workflows...Remote workHourly payFor contractorsWork at officeLocal areaImmediate start2 days per week- ...Specilist Location: Anywhere in US (Remote) Duration: 3 month... ...Manager, the Customer Access Specialist will be providing advanced services... ...tracking and submission c. Prior authorization assistance and tracking d.... ...coverage research h. Appeals/Denials i. Intakes and reports...Remote workWork at officeMonday to FridayShift workDay shiftAfternoon shift
$80k
...Location: This is a remote position, but candidates will happy to work on either... ...is recruiting for two Access Specialist's to join our growing Metabolic team... ...verify insurance coverage, obtain prior authorizations and support appeals processes. As part of your role, you...Remote work$24 - $26 per hour
...Utilization Review Specialist - Behavioral Health (Remote) PHP/IOP | Full-Time | Monday... ...Specialist to manage insurance authorizations for adolescent and adult... .... Complete prior authorizations, pre-certifications... .... Submit denial appeals and coordinate peer-to-peer...Remote workFull timeMonday to Friday$18.99 - $29.22 per hour
...Precertification Specialist Join RCCA and make a meaningful impact... ...journey. As a fully remote Precertification Specialist... ...for obtaining and managing prior authorizations to ensure patients receive... ...authorizations, submitting appeals when necessary Resolves...Remote workFull timeTemporary workFlexible hours- ...About this job Job Title: Prior Authorization Specialist Location: Fully remote Duration: 12 months contract Prior Authorization Specialist takes in-bound calls... .... Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. Must...Remote workContract work
- ...steps. Our partner is looking for a Lead Specialist, Appeals & Grievances based in the United... ...responses to members, providers, and authorized representatives. Research claims... ...retirement plans, paid time off, and remote or flexible work arrangements are not...Remote workFull timeContract workWork at officeFlexible hours
- ...Supports the documentation and processing of appeals, disputes and reconsiderations to ensure... ...timely. Key Details: Must be authorized to work in the U.S. without the need for... ...holidays, and a flexible approach to work with remote, hybrid, field or office work schedules....Remote workFull timePart timeH1bWork at officeFlexible hours
$24.5 - $37 per hour
...be providing expertise in the area of prior authorization and will be responsible for implementing... ...authorization requests, along with all related appeals through to EMR. Participate in... .... Medical device experience. #LI-Remote The salary for this position will be...Remote workHourly payFull timeWork experience placementWork at officeLocal areaFlexible hoursShift work- 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
$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract... ...Utilization Management experience Experience with prior authorizations and medical necessity reviews Grievance &...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- ...DUTIES: The Medication Access & Adherence Specialist plays a dual role in supporting timely... ...is responsible for managing prior authorization (PA) processes while proactively engaging... ...environment. Dedicated home office space for remote work flexibility, as role is assigned/...Remote workWork at officeWork from homeHome office
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