Appeals Specialist - Nashville

The Appeals Specialist will be responsible for performing end-to-end tasks for technical appeals. · Review records for the Appeals team, validating appeal criteria is met. · Compose technical denial arguments for reconsideration. · Identify contract protection to leveraged overtu ...

The Division of TennCare is seeking an Appeals Resolution Specialist for the Appeals Operations Group within Member Services. · The role will provide support and guidance on matters relating to Medicaid rules, regulations and policies, · and ensure that due process standards are ...

We are seeking an Appeals Specialist for our team to ensure that we continue to provide all patients with high quality, · efficient care.We want you to apply · ...

The Appeals Specialist will be responsible for performing end-to-end tasks for technical appeals. · ...

Performs non-medical reviews and processes redetermination letters. · High School Diploma or equivalent · Two years job related field (insurance claims, medical office, or similar) · Demonstrated proficiency in word processing and spreadsheet software · ...

Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy. · ...

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. · Graduation from an accredited college or ...

The Appeals Specialist prepares and submits appeal packages ensuring compliance with payer policies and regulatory guidelines. · Prepare document and submit appeals for complex scenarios. · Coordinate appeal responses with business partners. · ...

The Appeals Specialist prepares and submits appeal packages. · Reviews documentation for accurate appeal language. · Maintains precise documentation with internal and external stakeholders. · ...

+The Clinical Appeals Specialist is a key clinical expert within the new Revenue Recovery Team at Amplify RCM. · +Perform comprehensive reviews of denied claims,focusing on clinical issues such as medical necessitylevel of care non-covered services,and authorization-related denia ...

The Appeals Specialist prepares and submits appeal packages ensuring compliance with payer policies and regulatory guidelines responsibilities include reviewing documentation for accurate appeal language monitoring appeal status and following up on outstanding cases the role requ ...

The Claims Appeals Specialist is responsible for reviewing and processing claims for pre services and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) related to clinical and non-clinical services, · quality of s ...

· Hybrid schedule: Nashville TN · About Lucent Health  · Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan parti ...

+The Claims Appeals Specialist is responsible for reviewing, analyzing and processing claims for pre services and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (i.e. HMO, POS, PPO, EPO, C ...

The Appeals Specialist prepares and submits appeal packages ensuring compliance with payer policies and regulatory guidelines. · Prepare document and submit appeals for complex scenarios ensuring appeals are well supported with clinical evidence coding guidelines and regulatory ...

The Appeal Specialist II - RN reviews and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. · This role logs and reviews denials for trend reporting, provides feedback to facilities, · and communicates payer updates to relevant stakeholders.Re ...

The Appeal Specialist II - RN reviews, analyzes, · and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. · ...

The Appeal Specialist II - RN reviews and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. · The role logs and reviews denials for trend reporting, provides feedback to facilities, and communicates payer updates to relevant stakeholders. · ...

The Appeal Specialist II reviews, analyzes and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. · This role logs and reviews denials for trend reporting, provides feedback to facilities, · and communicates payer updates to relevant stakeholde ...

This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital. Do you want to join an organization that invests in you as a Medical Insurance Top Dollar Appeals Specialist? At Parallon, you come firs ...