Medicare Claims Appeals Specialist

Job SummaryMolina Healthcare is seeking a highly skilled and experienced Director, Appeals to lead the Appeals and Grievances Unit. The successful candidate will be responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by...

About SCANSCAN Group is a not-for-profit organization dedicated to addressing the most pressing issues affecting older adults in the United States. As a leading expert in senior healthcare, SCAN has been a mission-driven organization for over 45 years, committed to keeping seniors healthy and independent. Our team of talented professionals is passionate...

Medicare Reimbursement Analyst Job Description **Key Responsibilities:** * Collaborate with project leads and managers to deliver high-quality results for clients * Ensure timely completion of tasks and thorough review of projects before submission * Partner with team members to review and test Medicare bad debt claims **Required Qualifications:** * 2+...

Medicare Pharmacy Coordinator Job Description **Job Summary** VirtualVocations is seeking a highly skilled Medicare Pharmacy Coordinator to join our team. As a key member of our operations team, you will be responsible for ensuring the smooth administration of daily pharmacy operations in compliance with Medicare Part D and Part C benefit programs. **Key...

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...

Job Title: Claims AssociateJob Summary:Cynet Systems is seeking a skilled Claims Associate to join our team. As a Claims Associate, you will be responsible for processing low-level workers compensation claims, determining compensability and benefits due, and administering action plans to resolution.Key Responsibilities:Process low-level workers compensation...

Job Title: Medical Claims ExaminerWe are seeking a highly skilled Medical Claims Examiner to join our team at Ultimate Staffing. As a Medical Claims Examiner, you will be responsible for reviewing and processing medical claims to ensure accuracy and compliance with industry guidelines.Responsibilities:Review and process medical claims to ensure accuracy and...

Job Title: Grievance and Appeal Lead/SupervisorVerda Healthcare, Inc. is seeking a highly skilled Grievance and Appeal Lead/Supervisor to join our team. As a key member of our organization, you will be responsible for resolving grievances and appeals in a timely and efficient manner, ensuring compliance with CMS and regulatory requirements.Key...

Job SummaryWe are seeking a highly skilled Medical Claims Examiner to join our team at Ultimate Staffing. As a Medical Claims Examiner, you will be responsible for reviewing and processing medical claims, ensuring accuracy and compliance with industry guidelines.Key ResponsibilitiesReview and process medical claims, including professional and facility...

Job Title: Claims Audit ManagerJob Summary:We are seeking a highly skilled Claims Audit Manager to join our team at Advanced Medical Manage. The successful candidate will be responsible for ensuring the accuracy and compliance of claims processing, as well as providing expert guidance on Medicare and Medi-Cal claim payment rules and requirements.Key...

Job Title: Claims Audit ManagerAdvanced Medical Manage is seeking a highly skilled Claims Audit Manager to join our team. As a Claims Audit Manager, you will be responsible for ensuring the accuracy and compliance of claims processing in accordance with AMM policies and procedures.Key Responsibilities:Prepares and coordinates the completion of complex...

Job Title: Claims Audit ManagerAdvanced Medical Manage (AMM) is seeking a highly skilled Claims Audit Manager to join our team. As a Claims Audit Manager, you will play a critical role in ensuring the accuracy and compliance of claims processing within our organization.Key Responsibilities:Prepares and coordinates the completion of complex regulatory and...

Job Title: Claims Audit ManagerAdvanced Medical Manage is seeking a highly skilled Claims Audit Manager to join our team. As a Claims Audit Manager, you will be responsible for ensuring that incoming claims are processed in accordance with policies, procedures, and guidelines, as outlined by AMM and contractual agreements.Key Responsibilities:Prepares and...

Job Title: Workers Compensation Claims RepresentativeSedgwick is a leading provider of workers' compensation and disability management solutions. We are seeking a highly skilled and motivated Workers Compensation Claims Representative to join our team.Job Summary:The Workers Compensation Claims Representative will be responsible for processing low-level...

VirtualVocations is seeking a skilled Claims Resolution Specialist to join our team. As a Claims Resolution Specialist, you will be responsible for assisting customers with navigating auto loss claims through effective communication. You will conduct thorough investigations and assess claims to determine coverage and negotiate settlements. Additionally, you...

Medical Biller Job DescriptionWe are seeking a highly skilled Medical Biller to join our team at JOSEPH VARDAYO MD INC. As a Medical Biller, you will be responsible for processing insurance claims, collecting necessary documentation from clients, and communicating with physicians' offices and hospitals to obtain records.Key Responsibilities:Process insurance...

About the RoleThe Appeals and Grievances team at Blue Shield of CA is seeking a highly skilled and experienced professional to join our team as an Appeals and Grievances Representative, Advanced. In this role, you will be responsible for handling incoming appeals and grievances, researching and resolving complex issues, and providing exceptional customer...

About the RoleWe are seeking a skilled Workers Compensation Claims Representative to join our team at Sedgwick. As a key member of our claims team, you will be responsible for processing low-level workers compensation claims, determining benefits due, and ensuring ongoing adjudication of claims within company standards and industry best practices.Key...

Job DescriptionRole OverviewThe Claims Examiner III is a critical role within the Advanced Medical Manage team, responsible for ensuring the quality and accuracy of claims processing. This position requires a strong analytical mind, excellent problem-solving skills, and the ability to work effectively in a fast-paced environment.Key ResponsibilitiesAudit...

Job Title: Medical Claims ExaminerThis is an exciting opportunity to join our team as a Medical Claims Examiner in the greater Long Beach/Los Angeles area. As a key member of our Claims department, you will play a crucial role in ensuring the accuracy and efficiency of our claims processing.Responsibilities:Audit claims processing quality and develop reports...