A company is looking for a Medicare Claims Appeals and Grievances Specialist to review and resolve member and provider complaints.
Key ResponsibilitiesResearch and resolve appeals, disputes, grievances, and complaints from members and providersRequest and review medical records and formulate conclusions in accordance with regulatory guidelinesPrepare appeal summaries and written responses to provider reconsideration requests related to claims paymentRequired QualificationsHigh School Diploma or equivalencyMinimum 2 years of operational managed care experienceHealth claims processing background, including coordination of benefits and eligibility criteriaFamiliarity with Medicaid and Medicare claims denials and appeals processing
Medicare Claims Appeals Specialist
A company is looking for a Medicare Claims Appeals and Grievances Specialist to review and resolve member and provider complaints. ...
Medical Claims/appeals Specialist
Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and accurate submissions. Review and analyze denied claims, payment discrepancies, and reimbursement issues to identify the root causes. Stay up-to-date with payer policies, regulations, and indus...
Departmental Charge Specialist (On-Site Medical Billing/Registration/Coding)
Must have three (3) years’ experience in a hospital or business office setting to include experience in the areas of medical billing, registration, or coding. Ensures complete and accurate information is provided for coding and billing to ensure revenue is maximized. ...
Senior Claims Technical Operations Specialist
Senior Claims Technical Operations Specialist. The Technical Operations Specialist position will work with internal and external stakeholders and will report to the AVP of Claims Operations. It will require the individual to possess an excellent understanding of the (LOB) Claims business functions, ...
Medical Billing Specialist
A company is looking for a Healthcare A/R Specialist with extensive experience in medical billing and revenue cycle management. ...
Departmental Charge Specialist (On-Site Medical Billing/Registration/Coding)
Must have three (3) years' experience in a hospital or business office setting to include experience in the areas of medical billing, registration, or coding. Ensures complete and accurate information is provided for coding and billing to ensure revenue is maximized. ...
Workers' Compensation Claims Specialist (California) | Remote
Our client, an A-rated Insurance Carrier, is seeking to add an experienced California Workers' Compensation Claims Specialist to join their team in a fully remote capacity (must reside in the state of California). This person will be responsible for managing moderate to complex California Workers' C...
Billing Specialist
Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Billing Specialist opening with MSO - MSO Heart Center for Children today and find out what it truly means to be a part of the HCA Healthcare team. We are seeking a(an) Billing Specialist for...
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Service Contracts & Billing Specialist. The Service Contracts & Billing Specialist is responsible for all aspects of contract administration and controlling, customer invoicing and crediting, cross charge management in compliance with Computacenter’s systems, commercial policies, and process...
Claims Specialist I, General Liability
As a General Liability (GL) Claims Specialist, you will work with a diverse team of claims professionals. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facil...