Specialist, Appeals

OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day operations according to defined...

**Denials Analyst/Patient Accounting Specialist** **Department**: PFS - REVENUE RECOGNITION **City**: Rancho Mirage, CA **Hours Per Day**:8.00 **Responsibilities**: - Research and resolve claim denials, ADR requests, and certifications. - Submit and track appeals, noting trends, and providing monthly reports. - Respond to audit requests from payors,...

**Denials Analyst/Claims Specialist** **Location**:Rancho Mirage, CA **Department**:PFS - REVENUE RECOGNITION **Hours Per Day**:8.00 **Hours Per Week**:40.00 **Days Per Week**: 5.00 (Monday to Friday) **Job Requirements**: **Experience with Epic Hyperspace**: - **HB Billing**: Hospital Billing module - **Claims**: Managing and processing claims -...

Job Details: - Position: Denials Analyst - Location: Rancho Mirage, CA - Duration: 13 Weeks Contract - Shift: 8 Hour Shift **Responsibilities**: - Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations. - Analyze denied, underpaid and unpaid claims....

Job DescriptionJob DescriptionTitle: Denials Analyst - CAType: ContractDuration: 3 MonthsStart Date: ASAPJob Summary:Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends, and providing monthly reports. Responds to audit requests (including RAC) from payors. Maintains a Library of...

Are you a data-driven professional with a passion for healthcare and a knack for uncovering insights from complex data sets? Med Solutions LLC is seeking a talented Denial Analytics Specialist to join our dynamic team. This role offers a unique opportunity to contribute to the optimization of our healthcare services and improve patient outcomes by addressing...

Summary: The Revenue Cycle Specialist is responsible for billing and collecting payments. This position ensures that all accounts are billed appropriately and meets all regulatory and compliance requirements. Role and Responsibilities: Respond to inquiries from insurance carriers, via telephone, email or fax and demonstrate a high level of customer service....

Job Description: Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports. Responds to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation...

Description:The Patient Access Specialist is responsible for various functions in support of patient access to the SPRINT PNS System including but not limited to collaborating with payers, providers, patients, field sales representatives and other functional areas within the company. Through our SPRcare Patient Access Program, the Patient Access Specialist...

Description:The Patient Access Specialist is responsible for various functions in support of patient access to the SPRINT PNS System including but not limited to collaborating with payers, providers, patients, field sales representatives and other functional areas within the company. Through our SPRcare Patient Access Program, the Patient Access Specialist...

Job DescriptionJob DescriptionPosition Summary:Under the direction of the Manager, Pharmacy Program, the Clinical Pharmacist is responsible to review prior authorizations, provide clinical recommendations to Providers, and provide clinical education and guidance to the pharmacy team. This position is Remote after onsite orientation for Southern California...

**Education** Required: High School diploma or equivalent Preferred: Associate degree **Licensure/Certification** Preferred: Certified coder or currently enrolled in a coding program **Experience** Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing...

**Job Title: Denials Analyst** **Location - Rancho Mirage, CA** **OT: 8 hour shifts - OT after 8 hours** **Insurance Requirements: CERTIFICATE OF LIABILITY INSURANCE** **Education** - Required: High School diploma or equivalent - Preferred: Associate degree - Licensure/Certification - Preferred: Certified coder or currently enrolled in a coding...

1. Develop and implement medical policy for utilization management activities and functions, including benefit manual statement, policies and procedures, and Utilization Management Subcommittee Guidelines. Provide training and consultation for both internal staff and medical personnel of the Plan regarding policy application.2. Provide direction and control...

Position Description An Assistant Federal Public Defender must be (1) a graduate of an accredited law school; (2) admitted to practice before a state bar, but a Texas bar license is strongly preferred; and (3) licensed to practice in the U.S. District Court for the Western District of Texas prior to entry on duty. Spanish-language fluency is required....

DCFS is deeply committed to the welfare and protection of children. Our goal is to protect children by strengthening and supporting families. In every effort, from receiving hotline calls to reaching family reunification or foster care and adoption, children and families are our focus. Agency : Department of Children and Family Services Title: Child...

Job DescriptionJob DescriptionJob Title: Denials AnalyticsLocation: Rancho Mirage, CAContract positionPay: $24.71 an hour!Job Objective: Responsible for researching and resolving claim denials, ADR requests, and certs, submitting and tracking appeals, noting trends, and providing monthly reports.Respond to audit requests (including RAC) from payors.Maintains...

Job DescriptionJob DescriptionJob Title: Denials AnalyticsLocation: CA (Onsite)Job Objective: Responsible for researching and resolving claim denials, ADR requests, and certs, submitting and tracking appeals, noting trends, and providing monthly reports.Respond to audit requests (including RAC) from payors.Maintains a Library of Payer reference material...

Xtend Healthcare is a revenue cycle management company focused exclusively on the healthcare industry. The company's services range from full revenue cycle outsourcing, A/R legacy cleanup and extended business office to coding and consulting engagements. As part of Navient (Nasdaq: NAVI), Xtend taps the strength and scale of a large-scale business...

Description THE POSITION: Our Pulmonary/Critical Care team is seeking a full time certified/licensed NP with 2+ years of pulmonary and critical care experience. This position is strictly outpatient working in a busy clinic providing patient care and support to pulmonary patients. Clinic Hours are M-F: 8-5. You will collaborate with, work alongside and be...