Specialist, Appeals

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the...

Job Description Job Summary The Specialist, Member Rights serves as a member advocate within the agency. This position ensures that members are informed of their rights and supports members through mediation and problem solving with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to...

**JOB DESCRIPTION****Job Summary**Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.**We are seeking a Registered Nurse with previous Inpatient/outpatient appeals knowledge/experience. The candidate should have MCG criteria knowledge, critical thinking skills, and strong...

Job DescriptionJob DescriptionJob Summary The Specialist, Member Rights serves as a member advocate within the agency. This position ensures that members are informed of their rights and supports members through mediation and problem solving with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to...

Job DescriptionJob DescriptionJoin our dynamic experiential marketing team as a Product Specialist focused on live events. As a key player in our immersive brand experiences, you will play a crucial role in showcasing and promoting our products in a live and engaging environment. If you have a passion for creating memorable moments, a deep understanding of...

Job DescriptionJOB DESCRIPTIONJob Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding...

Job Description: Position is fully remote and will be a temp role through 3/31/23. Position has the option to go perm based on positive work. Candidates can sit anywhere in the US and schedule will be M-F 9AM-5PM local time. The training schedule will be M-F 9AM-5PM EST. Daily responsibilities will include the following: Candidates will be reviewing medical...

Akerman LLP, a top 100 U.S. law firm serving clients across the Americas, is seeking a Billing Specialist to join the firm's Financial Services Department. Akerman has adopted a hybrid workplace environment, and this position can be based in any of our U.S. offices. The Billing Specialist will coordinate and administer all facets of client account analysis...

Job DescriptionJob DescriptionOverviewAvanath is proud to be named one of the top property management companies to provide affordable housing for the work force.Cultivating the American Dream is the purpose that binds the Avanath team. At Avanath, every day is an opportunity to make a difference in someone's life. Whether it is helping residents call one...

Job DescriptionJob DescriptionThe billing specialist is responsible for obtaining and following up on payments from patients and insurances based on established contracts.ResponsibilitiesReview and process account adjustments and overpayment refunds in an efficient and timely mannerRespond to detailed questions from patients and payers regarding claims or...

Job DescriptionJob DescriptionThe billing specialist is responsible for obtaining and following up on payments from patients and insurances based on established contracts.ResponsibilitiesReview and process account adjustments and overpayment refunds in an efficient and timely mannerRespond to detailed questions from patients and payers regarding claims or...

Used Vehicle Acquisition SpecialistJoin our dynamic team at Performance Nissan, a leading automotive dealership renowned for its exceptional customer service and extensive inventory of high-quality pre-owned vehicles.We are dedicated to providing our customers with top-notch vehicles and service, and we're currently seeking a skilled individual to join us as...

Your RoleThe Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including...

Job DescriptionJob DescriptionUsed Vehicle Acquisition SpecialistJoin our dynamic team at Performance Nissan, a leading automotive dealership renowned for its exceptional customer service and extensive inventory of high-quality pre-owned vehicles. We are dedicated to providing our customers with top-notch vehicles and service, and we're currently seeking...

Job DescriptionJob DescriptionUsed Vehicle Acquisition SpecialistJoin our dynamic team at Performance Nissan, a leading automotive dealership renowned for its exceptional customer service and extensive inventory of high-quality pre-owned vehicles. We are dedicated to providing our customers with top-notch vehicles and service, and we're currently seeking...

OverviewJOB TITLE: LEASING SPECIALIST FLSA Non-ExemptPrimary Function The Leasing Specialist responsibilities include but are not limited to support the Property Manager with the daily operations of the community, providing assistance to the functions of leasing, collections, resident services and maintenance administration, handling telephone and on-site...

Job Summary The Accounts Receivable Collection Specialist's purpose is to process medical billing claims, collect patient or provider payments, resolve questions and problems with a customer's accounts, process patient refunds, appeals to include re-determinations and resubmissions of billing to patient payers for payment on medical supply orders Job...