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...time off
~ Eight Paid Holidays per year
~ Quarterly incentive plans
*The Akron, OH billing center has multiple openings for Appeals Representatives. These are remote, work-from-home positions*
JOB DESCRIPTION OVERVIEW:
~ The Denials & Appeals...
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...appropriate.
Provide correction suggestions to other departments so the invoice can be resubmitted.
Provide coding direction to appeal invoices and/or submit appeals via payer website or fax, as directed.
Complete reconsideration letters as needed.
Complete...
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...and the United Kingdom.
The Atlantic Region CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse.
The Clinical Documentation Improvement (CDI) Nurse provides clinically based concurrent and retrospective review of inpatient...
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Local area
Overview:
Appeals associate will be responsible for coordinating and monitoring the administrative and non-clinical services for the... ...required .Print Medical records- Admission notes, Progress notes, Nurse progress notes, Medical order, Lab results (15 to 20 cases per...
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...JOB DESCRIPTION
For this position we are seeking a (RN) Registered Nurse who must be licensed in the state you reside.We are looking for a Clinical Nurse Appeals RN to support our SC Health plan (Medicaid and Marketplace). Strong experience with appeals reviews and...
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Full time
Work experience placement
Home office
Weekend work
Monday to Friday
...Job Description
Division/Unit: Appeals Division
Position Title: Appeals Paralegal
Civil Service Title: Community Associate
Salary Range: $49,000 - $51,984
Job Description:
The New York County District Attorney's Office anticipates openings beginning in...
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Monday to Friday
...respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Coordinate the internal appeals and grievances process by supporting entry of requests in timely manner to internal decision makers. Provide supporting compliance...
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...Appeal Experience REQUIRED
RESPONSIBLE FOR:
Detailed review, analysis and extraction of clinical information from patient medical... ...EDUCATION REQUIRED:
Graduate from an accredited School of Nursing
MINIMUM EXPERIENCE REQUIRED:
Clinical experience in healthcare...
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...Become a part of our caring community and help us put health first
The G&A rep 3 investigates and resolves grievances and appeals submitted by members and providers. Exercises discretion and judgement in prioritizing cases and interpreting procedures and processes....
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Apprenticeship
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Saturday
...Appeals and Compliance Specialist
Starting Salary: $84,495 - $101,395
This position reports to the Executive Director and is responsible for managing complaints, informal resolution meetings, mediations, and appeals, ensuring compliance with state and federal laws...
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Local area
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...Grievance and Appeals Coordinator
75 Vanderbilt Ave, Staten Island, NY 10304, USA
Req #660
Monday, April 1, 2024
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision...
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Hourly pay
Overview:
The Denial Appeals Specialist, functions as a hospital liaison with external third-party payers to review denied claims and write appeals for such claims and retrospectively pre-certify Medicaid, Medicare and private insurance accounts.
Responsibilities...
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Overview:
Under the direction of the Supervisor, the Medicare Appeals Specialist receives, investigates, and responds to formal Medicare appeals. The Medicare Appeals Specialist is responsible for evaluating clinical criteria within medical records and associated documentation...
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...Summary of Position
We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations...
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Work experience placement
...Job Description:
The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies.
The Coordinator is expected to analyze the customer...
...Financial Officer ensures accuracy of denial reporting to include investigation and root cause analysis of denials, management of the appeals process with payers, and subsequent reporting to appropriate persons within the facility and corporate office. Responsible for...
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Day shift
...Job Description
Role : Appeals Project Specialist
Estimated Duration : 6+ months
Location: Phoenix, AZ (hybrid)
Position Description
Reviewing medical records and writing administrative reviews- looks at recommendations by doctors, learning Client rules...
Remote job
oPerforms daily quality assessments for all function areas of the Appeals and Grievances Department to assure the integrity of processes - for all lines of business.
oReviews include assessments of the decision-making process through the life of the appeal and assuring...
...Long Islands finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.
At Catholic Health, our primary...
....
With more than 13,000 team members physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals,... ...JOB SUMMARY
This position is responsible for managing the appeal of unpaid claims in the Central Business Office. This position will...
...Description
Heard and Smith, LLP
Case Status and Appeals Representative
Heard and Smith, LLP was founded on the principles of compassion, humility and the relentless desire to pursue financial assistance for our clients. Our law firm has been helping the disabled...
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Immediate start
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Home office
...UAE
United Kingdom
United States
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Appeals & Grievances (Member and Provider)
Appeals & Grievances (Member and Provider)
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...Job Description
Claims Appeals Representative *Remote* Candidates in AK, WA, MT, OR, CA or TX are encouraged to apply.
The Appeal and Grievance Specialist position is responsible for day-to-day review, coordination and management of technical denials requiring background...
Remote job
Local area
Shift work
...to being a vital partner for health solutions in the public sector.
Acentra is currently looking for a Utilization Management Appeals Nurse – LPN/RN to join our growing team.
Job Summary:
Our Utilization Management Appeals Nurse – LPN/RN will help orchestrate the...
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Monday to Friday
...many factors such as geography, experience, education, and the market. The range is subject to change. We are hiring an Appeals and Grievances Nurse to join our team!
Remote - Must reside in California!
What You Will Be Doing:
Under general supervision, the...
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Flexible hours
...Senior Grievance and Appeals Specialist
VillageCare is looking for a self-motivated individual for a Full Time role as the Senior Grievance Specialist. This role is responsible for the investigation and resolution of all Medicare and Medicaid lines of business complaints...
Holiday work
Full time
Work from home
...Job Description:
The Denials and Appeals Specialist follows up on denied claims from commercial and contracted payers. Performs... ...follow up for assigned patients. Communicates with third party nurse reviewers or via clinical documentation inquiry any related missing...
Work experience placement
...assigned denials to determine appropriate action based on payer requirements.
Assembles and prepares required documentation for appeal in billing system to appeal disputed claims.
§ Assembles and forwards required documentation for payer guidelines.
§ Maintains...
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For contractors
Local area
...Job Summary: The Grievance and Appeals Nurse Specialist participates in managing medical appeals and state hearing reviews for all lines of business including handling expedited and standard requests. The incumbent will ensure appeals and state hearing requests are...
Weekly pay
Full time