- UCLA Health (Los Angeles, CA)
- …to support UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to ... in clinical coding or compliance, strongly preferred + Basic understanding of audit and appeals processes, including methods, tools, and regulatory standards… more
- McLaren Health Care (Bay City, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met...support in response, tracking and completion of all payer audit /denial/appeal activity to ensure that timelines in the process… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a number of ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Intermountain Health (West Valley City, UT)
- …been denied. + Conducts and refers patient accounts when requested by payers, audit firms, patient and RCO departments to determine the appropriateness of billed ... Physician Advisor and works with them for obtaining support for appeals . + Collaborates with Care Management, Physician Advisors, Revenue Integrity, Compliance,… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and… more
- BrightSpring Health Services (Englewood, CO)
- …healthcare professionals. Providing service to all the Amerita locations, the PBM Payer Audit Specialist reviews audit request, compiles and classifies ... and identifies documentation needed to respond effectively and efficiently. The PBM Payer Audit Specialist also performs quality assurance checks for all medical… more
- Baptist Memorial (Memphis, TN)
- Summary The Denial Mitigation Specialist - Denial Escalation Quality Assurance evaluates the adequacy and effectiveness of internal and operational controls designed ... including federal and state regulations and guidelines. The Quality Assurance Specialist will be responsible for analyzing and interpreting trends associated with… more
- Molina Healthcare (Wauwatosa, WI)
- **Job Description** **Job Summary** The Specialist , Member Rights serves as a member advocate within the agency. This position ensures that members are informed of ... solving with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to utilize. **Essential Job Functions**… more
- Hartford HealthCare (Farmington, CT)
- …departments as needed . Manages relationship with external denials vendor. Reviews audit findings and schedules quarterly meeting to provide updates on denial ... as needed to determine the appropriate course of denial appeals . . Maintains accurate, clear, timely documentation related to.... Assists with processing HIM Coding validation denial and audit finding letters to third party vendor. . Monitors… more