Current jobs related to Appeals Specialist - Daytona Beach - Unavailable

  • Claims and Appeals Specialist

    2 months ago

    Myrtle Beach, South Carolina, United States BlueCross BlueShield of South Carolina Full time

    Job Title: Claims and Appeals SpecialistAbout the RoleWe are seeking a highly skilled Claims and Appeals Specialist to join our team at BlueCross BlueShield of South Carolina. As a Claims and Appeals Specialist, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.Key ResponsibilitiesClaims Processing:...

  • Medicare Claims Appeals Specialist

    2 weeks ago

    Long Beach, California, United States Morgan Stephens Full time

    Job Title: Medicare Claims Appeals ClerkMorgan Stephens is seeking a highly skilled Medicare Claims Appeals Clerk to join our team.Job SummaryThe Medicare Claims Appeals Clerk is responsible for reviewing and resolving member and provider complaints, and communicating resolutions to members and providers (or authorized representatives) in accordance with...

  • Grievance and Appeal Resolution Specialist

    3 weeks ago

    Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full time

    Job Title: Grievance & Appeal Lead/SupervisorJob SummaryVerda Healthcare, Inc. is seeking a highly skilled Grievance & Appeal Lead/Supervisor to join our team. As a key member of our organization, you will be responsible for resolving written and verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with CMS...

  • Recovery Reimbursement Specialist

    2 weeks ago

    Daytona Beach, Florida, United States Unavailable Full time

    Job SummaryWe are seeking a highly skilled Recovery Reimbursement Analyst to join our team at Halifax Health. As a key member of our revenue cycle team, you will play a critical role in ensuring that our organization receives accurate and timely payments for delivered services.Key ResponsibilitiesEvaluate variances on paid claims and perform contract...

  • Recovery Reimbursement Specialist

    2 weeks ago

    Daytona Beach, Florida, United States Unavailable Full time

    Job SummaryHalifax Health is seeking a skilled Recovery Reimbursement Analyst to join our team. As a key member of our revenue cycle team, you will be responsible for ensuring accurate and timely payment for delivered services.Key Responsibilities:Evaluate variances on paid claims and perform contract analysis to validate accuracy of programmed contract...

  • Morning Culinary Specialist

    2 months ago

    Daytona Beach, Florida, United States Hilton Daytona Beach Oceanfront Resort Full time

    Position Overview:We are in search of a dedicated Breakfast Cook to deliver exceptional culinary experiences for our guests.Key Responsibilities:Meticulously follow established recipes to guarantee high-quality food preparation.Skillfully handle a variety of ingredients, including fruits, vegetables, and meats.Prepare a range of appealing dishes, such as...

  • Marketing Materials Specialist

    7 days ago

    Long Beach, California, United States United Pacific Full time

    Job DescriptionThe Marketing Materials Specialist is responsible for developing and implementing marketing strategies to promote United Pacific's retail locations. This includes creating visually appealing marketing materials, such as graphics and signage, to drive brand awareness and sales. The Specialist will work closely with Category Managers and product...

  • Retail Product Specialist

    4 weeks ago

    Manhattan Beach, California, United States Skechers U.S.A. Full time

    Skechers Retail Product Specialist Job DescriptionSkechers U.S.A. is seeking a highly motivated and customer-focused Retail Product Specialist to join our team. As a key member of our sales floor team, you will be responsible for providing exceptional customer service, maintaining a visually appealing sales floor, and working collaboratively with colleagues...

  • Nocturnist Physician Specialist

    2 weeks ago

    Daytona Beach, Florida, United States Recruitment Reimagined Full time

    Dynamic Nocturnist Physician OpportunityWe are seeking a highly skilled and dynamic Nocturnist Physician to join our esteemed team of Hospitalists at our highly rated hospital in Daytona Beach, FL.About the RoleThe Nocturnist Physician will be responsible for providing high-quality patient care in a dynamic and fast-paced environment. The ideal candidate...

  • Retail Product Specialist

    4 days ago

    Manhattan Beach, California, United States Skechers U.S.A. Full time

    About the Role:Skechers U.S.A. is seeking a skilled Retail Product Specialist to join our team. As a key member of our sales floor team, you will be responsible for engaging customers, meeting their needs, and ensuring a positive shopping experience. Your attention to detail and ability to work effectively in a fast-paced environment will be essential in...

  • Retail Product Specialist

    1 week ago

    Pismo Beach, California, United States Skechers U.S.A. Full time

    About the Role:Skechers U.S.A. is seeking a skilled Retail Product Specialist to join our team. As a key member of our sales floor team, you will be responsible for engaging customers, meeting their needs, and ensuring a positive shopping experience.Key Responsibilities:Engage customers and provide exceptional customer service.Treat shoes and accessories...

  • INSURANCE SPECIALIST I

    4 weeks ago

    Pompano Beach, United States Patient Care America Full time

    Job DescriptionJob DescriptionJOB SUMMARY:The Insurance Specialist I is responsible for completing patient eligibility and benefits checks to determine patient coverage/responsibility for services including, but not limited to primarily major medical insurance benefits verification, complex insurance plan verification, and high volume PBM plans. The...

  • Retail Product Specialist

    1 week ago

    Panama City Beach, Florida, United States Skechers U.S.A. Full time

    Job Summary: As a Retail Product Specialist at Skechers, you will be responsible for creating an exceptional customer experience by engaging with customers, presenting products in a visually appealing manner, and working collaboratively with the team to achieve sales goals.Key Responsibilities: Greet and meet customers to understand their needs Maintain a...

  • Breast Surgeon Opportunity in Coastal Florida

    1 week ago

    Daytona Beach, Florida, United States AdventHealth Central Florida Full time

    AdventHealth is seeking a dynamic and quality-focused breast surgeon to join our team of specialists at our CMS 5 Star / Leap Frog Grade A rated hospital in Daytona Beach, FL.We are looking for a surgeon who will model and lead excellence in clinical practice, doctor-patient relationships, and professionalism while maintaining AdventHealth's Mission, Vision,...

  • Visual Merchandising Specialist

    2 weeks ago

    West Palm Beach, Florida, United States AMBASSADOR RETAIL Full time

    Part-Time Visual Merchandising OpportunityAmbassador Retail is seeking a skilled Visual Merchandising Specialist to provide part-time support for apparel and accessory brands in department stores located in the West Palm Beach, FL area.As a Visual Merchandising Specialist, you will be responsible for executing high-level merchandising plans, ensuring...

  • Sales Specialist

    3 days ago

    Virginia Beach, Virginia, United States Target Full time

    Key Responsibilities:• Work in a fast-paced, dynamic environment to deliver exceptional guest experiences.• Provide personalized service to guests, ensuring they feel welcomed, inspired, and rewarded.• Maintain a well-stocked and visually appealing store environment, including setting and selling Target products.• Collaborate with team members to...

  • Product Presentation Specialist

    2 weeks ago

    West Palm Beach, Florida, United States Floor & Decor Full time

    Merchandise SpecialistAt Floor & Decor, we're seeking a skilled Merchandise Specialist to join our team. As a key member of our retail team, you'll play a vital role in maintaining store merchandising standards and ensuring pricing integrity.Key Responsibilities:Manage price changes and execute product SKU labelingProcess returned merchandise and identify...

  • Instructional Media Specialist

    1 month ago

    Deerfield Beach, Florida, United States IPC Corporation Full time

    Job Title: Instructional Media SpecialistIPC Corporation is seeking an experienced Instructional Media Specialist to join our team. As an Instructional Media Specialist, you will be responsible for creating high-quality visual content to support our educational products and services.Key Responsibilities:Media Sourcing and Creation: Source or create photos,...

  • Food Preparation Specialist

    4 days ago

    Virginia Beach, Virginia, United States Commonwealth of Virginia Full time

    Job SummaryWe are seeking a highly motivated and experienced Food Preparation Specialist to join our team at the Jones & Cabacoy Veterans Care Center. As a Food Preparation Specialist, you will be responsible for preparing and serving meals to our residents, ensuring that they receive the highest quality food and exceptional service.Key...

  • Utilization Review Specialist

    4 weeks ago

    Newport Beach, California, United States Premier Health Group Full time

    Job Title: Utilization Review SpecialistThe Utilization Review Specialist at Premier Health Group plays a critical role in ensuring that services provided to clients are authorized by insurance companies, thereby securing payment for services. This position involves obtaining and tracking authorizations, ensuring timely communication with payers, and...

Appeals Specialist

4 months ago

Daytona Beach, United States Unavailable Full time
Overview

Halifax Health is seeking an Appeals Specialist for the PBFS - Administration Department.

Summary

The Appeals Specialist is responsible for monitoring and tracking the status of appeals submitted by the Clinical Appeals Representative. The position involves but is not limited to reviewing incoming denials for appropriateness, documenting the denial specifics into the current software, follow up on expected reimbursement and assisting with report development. The Appeals Specialist also provides follow up on aging clinical accounts on the DNFB and the AR Report. The position provides assistance and support to the Clinical Appeals Representative and the Revenue Integrity Coordinator. The Appeals Specialist requires a strong knowledge of hospital billing and reimbursement. This position also coordinates with the outpatient oncology center for documenting and tracking the denials and appeal of outpatient services. The Appeals Specialist works collaboratively with the staff and management involved in key areas of the revenue cycle, Case Management and Health Information Management.

Job Qualifications
  • High School Diploma or GED equivalent required. Associate's degree preferred.
  • Two years of hospital collections, recovery or appeals processing experience preferred.
  • Experience with managed care, governmental and/or RAC appeal process preferred.
  • Ability to work independently and in a multi-disciplinary team.
  • Ability to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions.
  • Ability to work collaboratively with other departments to positively affect clinical and financial outcomes.
  • Must have good PC knowledge and skills.
  • Must be able to work successfully in a team-work environment.
  • Excellent written and verbal communication skills.
  • Ability to communicate with multiple levels in the organization.
  • Critical thinking and analytical skills, problem solving skills, and the ability to prioritize and multi-task.
Job Duties and Responsibilities
  • Review incoming denials that generate from remit codes, the in-house denial process, letters or other departments within the organization. Determine if appropriate for clinical appeal and assign to the Clinical Appeal Representative.
  • Open new denials in the current software, documentation should include type of denial, appeal due date, expected reimbursement and any pertinent information to assist with the appeal process.
  • Assist Clinical Appeal Representative to track and meet appeal deadlines.
  • Provide follow up and documentation of outgoing appeals submitted by the Clinical Appeal Representative.
  • Scan pertinent documentation regarding denials and appeals into the medical record.
  • Obtain case pertinent information from other departments, i.e. coding, billing and recovery.
  • Notify the Case Management Department of aging accounts holding on the DNFB waiting for authorization.
  • Communicate with Case Management regarding pending denials for patients that are in-house.
  • Work with the appeals department staff to identify opportunities to improve the physical workflow processes within the appeals department.
  • Work with the Revenue Integrity Coordinator to develop, maintain and prepare departmental reports.
  • Coordinate and communicate with the outpatient oncology staff for notification of new denials and to assist with documenting, tracking and follow up on all outpatient oncology appeals.
  • Verify Medicaid authorizations, document the authorization numbers in the current system, and notify billing to release the claim for reimbursement.
  • Attend and participate in departmental meetings.
  • Regularly makes complex decisions within the scope of the position and is comfortable working independently.
  • Complies with state and federal regulations, compliance requirements, Halifax Health policy and procedures, including those regarding fraud and abuse, confidentiality, and HIPPA.
  • Participates in professional development to enhance job knowledge and performance.
  • Demonstrates teamwork and integrity in all work related activities.
  • Other duties as assigned.

About Us

Recognized as one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the areas largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in womens health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the areas only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks. For more information, visit halifaxhealth.org.