Appeals Specialist

The Appeals Specialists investigates the appeal requests, gathers all pertinent information to ensure the appeals committee can provide an accurate and fair determination. Completes the determination letter and follows through with completing appeals within the specified compliance timeframe. * Thoroughly investigates and responds to written/verbal appeal...

* Thoroughly researches and investigates appeals * Reviews appeal documentation to ensure all pertinent information is included * Makes member and provider outreach calls to gather information and answer questions * Makes outreach to other departments to confirm rules and guidelines * Documents investigation of member and provider contracts and other...

This Appeal Coordinator position is responsible for medical appropriateness review of and the coordination of appeal reviews by peer consultants. The primary responsibility of the Patient Care Coordinator-Appeal Coordinator is to evaluate the medical necessity of proposed and/or delivered plans of treatment by reviewing the member's medical documentation....

This Appeal Coordinator position is responsible for medical appropriateness review of and the coordination of appeal reviews by peer consultants. The primary responsibility of the Patient Care Coordinator-Appeal Coordinator is to evaluate the medical necessity of proposed and/or delivered plans of treatment by reviewing the member's medical documentation....

Company DescriptionWorld's No.1 online casino is hiring talent! At Evolution, our talent is live, the players are virtual. Evolution is a developer and supplier of virtual casino games, since 2006. We evolve the gaming industry by designing and hosting the most streamed, interactive casino tables and slots in the world. Every day, thousands play with real...

PeopleShare is recruiting for a Client Intake Specialist to support a Nonprofit Organization in Philadelphia! Job Selling points for Client Intake Specialist in Philadelphia:$20.00 per hourContract to Hire Monday - Friday, 8:30am - 4:30pm (With Paid Lunch Included)Job Responsibilities for Client Intake Specialist in Philadelphia:Supports case management by...

Job DescriptionJob DescriptionDescription:***Effective October 15, 2021, all employees/contractors/interns/volunteers are required to provide our office with proof of COVID vaccination.***Billing and Registration Specialist Shift: Monday-Friday 9:00AM-5:00PMOpenings:One (1) OpeningBilling and Registration Specialist Salary: $17.00/HRBilling and Registration...

The **Medical Payment Posting & Reconciliation Specialist** will manage accounts receivable billing and collection of payments for all designated payers and designated locations to meet and maintain goals. They will monitor A/R aging, accessing the accounts for further attention by involving the A/R; collect balances to ensure statements are processed and...

Description You are an expert facilitator: you open doors, foster communication, and bridge the gap. In this role, you will be responsible for the management of defined accounts in a specified geographic region in the respiratory therapeutic area, specifically supporting our client's products. The Field Reimbursement Specialist (FRS) will execute the...

Serves as the primary clinical resource in the PreCertification Department for the handling of complex authorization issues. Responsible for clinically assessing all adverse determinations made by insurers through all levels of the Pre-Service Administrative appeals process. Supports the Patient Access team (both management and staff) to ensure...

Job DescriptionJob DescriptionThe Medical Payment Posting & Reconciliation Specialist will manage accounts receivable billing and collection of payments for all designated payers and designated locations to meet and maintain goals. They will monitor A/R aging, accessing the accounts for further attention by involving the A/R; collect balances to ensure...

Description You are an expert facilitator: you open doors, foster communication, and bridge the gap. In this role, you will be responsible for the management of defined accounts in a specified geographic region in the respiratory therapeutic area, specifically supporting our client's products. The Field Reimbursement Specialist (FRS) will execute the...

The Creative Services Specialist’s primary focus will be executing marketing and communications activities which support the strategic goals of Centri Business Consulting, LLC (“the Firm”). This person will be responsible for the smooth execution of marketing activities within the marketing department and for helping drive growth and enhancing our...

The Creative Services Specialist's primary focus will be executing marketing and communications activities which support the strategic goals of Centri Business Consulting, LLC ("the Firm"). This person will be responsible for the smooth execution of marketing activities within the marketing department and for helping drive growth and enhancing our brand...

Summary Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities. Our highly-skilled, diverse, and innovative workforce creates a strong foundation of safety and security. Through the principles of humanity and normalcy, we develop good...

PHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers. JOB OVERVIEW: The Family Services Manager ensures the ELRC delivers responsive, timely services for families in accessing and selecting early...

PHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers. Job Overview: The Intake and Eligibility Coordinator is an essential member of the Family Services Team. This position is responsible for...

JOB SUMMARY Acts as a liaison with all insurance providers including commercial, managed care, and governmental plans Gathers and submits patient information to secure prior authorizations for inpatient IRF and LTACH admissions Gathers and transmits required documentation to the Medicare Administrative Contractor as required by CMS in the setting of...

Therapeutic Apheresis Nurse SpecialistPlease use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a...

Therapeutic Apheresis Nurse Specialist Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is...