Senior Specialist, Appeals - United States

Researches and responds to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process. May conduct phone calls with appellants for the purpose of scheduling phone discussions with the company decision maker. · ...

The position provides support for claims activities including reviewing and resolving member and provider complaints in accordance with the standards established by the Centers for Medicare and Medicaid Services. · ...

+ Academic Appeals Specialist + · American Public University System +The Academic Appeals Specialist is responsible for responding to student appeal requests, investigating and delivering appropriate appeal outcomes,+Responsibilities:Serves as a point of contact for first-level e ...

Description · Job Summary · 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 updat ...

Join our dynamic healthcare team as a Medical Claim Appeals Specialist. · Review and analyze denied or disputed insurance claims to identify reasons for denial and determine appropriate appeal strategies · Maintain organized records of all claim correspondence,Collaborate with he ...

Analyze, triage, investigate, research and process standard and escalated appeals , complaints or state complaints from members , providers , health plans and state agencies . · Able to work overtime as needed. · ...

The Appeals Support Representative role directly supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team.Essential Job Functions: · Complete outbound calls to payers for status updates on retro authorizat ...

Description · Job Summary  · The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial ...

The Medical Billing & Denials Specialist ensures that all patient/insurance information, charges, billings and follow-up on patient accounts is accurate, complete, · and timely. · ...

Description · Job Summary · The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating pr ...

The Manager is responsible for the day-to-day Appeals and Denials process by providing general oversight including leadership for the inpatient DRG/Coding Denials and Appeals process which includes tracking prioritizing trending and writing appeal letters identifying training and ...

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric model. · Confirm insurance benefits for patients · ...

We are seeking an Accounts Receivable Specialist to join our team in the Central Billing Office. The successful candidate will be responsible for supporting the efficient and effective financial operations of the hospital. · Support the Central Billing Office by working closely w ...

· OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to ...

About the Role · Impact you will make  · Are you an expert in healthcare insurance reimbursement? Do you thrive on solving complex insurance denials and underpayments? Join our team and play a vital role in ensuring hospitals receive the reimbursements they deserve. We're looking ...

The medical billing specialist will be responsible for all activities related to health insurance and medical billing. · ...

The Sr. Director, Clinical Denials, will serve as the primary clinical authority supporting clients with denial prevention, appeal strategy, payer policy compliance, and industry education. · Serve as the vendor's lead clinical subject matter expert on clinical denials management ...

The Payer Specialist is responsible for preforming duties of utilization review assisting case managers with patient accounts and timely payer authorizations. · Effective communication with payers, case managers, patient access, financial services and clinical disciplines to capt ...

The Payer Specialist is responsible for performing duties of utilization review assisting case managers with patient accounts patient type timely payer authorizations for initial and continued stay. · Effective communication with payers case managers patient access financial serv ...

SetPoint Medical's Market Access Specialist will facilitate patient access to support the launch of the first neuroimmune modulation therapy to treat rheumatoid arthritis in the US. · ...