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Appeals Specialist Jobs

Appeals Litigation Preparation Specialist - 48777
By State of TN At , $3,958 a month
Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
Four (4) years of experience within a Medicaid, managed care or healthcare organization.
Substitution of experience for education:
Advanced writing and communication skills
Four (4) years of experience within TennCare
Ability to maintain a high-volume caseload and adhere to the timeliness standard of appeals while conducting the due process review.
Denials/Medical Appeals Specialist
By Lahey Health Shared Services At , Burlington, Ma
Required Education: High School Diploma
Preferred Licensure, Certification & Registration: Medical Billing Certification
-To be eligible, you must be a non-BILH employee or a previous eligible employee who returns to BILH after 1 year.
-Previous employees returning within 1-Year are eligible for a retention bonus.
-Employee must be in good standing to receive the bonus at the time of payment.
-All bonuses are subject to applicable taxes. This program is subject to change at any point
Grievance & Appeals Specialist- Remote
By EmblemHealth At New York, NY, United States
Relevant Work Experience, Knowledge, Skills, And Abilities
Additional years of experience/training may be considered in lieu of educational requirements. (R)
Excellent organization and time management skills. (R)
Experience in a managed care/compliance environment. (P)
Determine eligibility, benefits, and prior activity related to the claims, payment or service in question.
3+ years of related professional work experience. (R)
Nurse Appeals Jobs
By Elevance Health At Florida, United States
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Resolving member clinical grievances (complaints).
Conducts investigations and reviews of member grievances and potential quality of care issues.
Reviews medical records for potential quality of care issues.
Extrapolates and summarizes medical information for medical director.
Nurse Appeals Jobs
By Elevance Health At United States
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Resolving member clinical grievances (complaints).
Conducts investigations and reviews of member grievances and potential quality of care issues.
Reviews medical records for potential quality of care issues.
Extrapolates and summarizes medical information for medical director.
Specialist, Appeals Jobs
By Experis At Columbia, SC, United States
Excellent organizational, customer service, and written and verbal communication skills.
Proficiency in spelling, punctuation, and grammar skills.
50% Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
30% Prepares unit reports, analyzes, and interprets workload, and processes issues utilizing various software tools.
10% Updates letters and documents within the department when necessary.
10% May gather and prepare documentation for legal inquiries and administrative requests.
Appeals And Grievances Lead
By Gold Kidney Health Plan At United States
· Exceptional time management skills.
· Promote a provider-friendly, customer service-oriented philosophy within the Fresenius Health Partners Utilization Management department.
· Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database, presentation and email applications.
· 2 – 4 years’ related experience required
· Medicare Advantage Appeals and Grievance experience required.
· Excellent analytical and leadership skills.
Quality Assurance Specialist, Appeals & Grievance
By Alignment Health At California, United States
Produces departmental quality performance reports for management review.
2+ years of managed healthcare experience.
Knowledge of Medicare Managed Care Plans required.
Possess the knowledge of Appeals and Grievance procedures and the Centers for Medicare (CMS) regulatory compliance guidelines.
Analyzes and validates accuracy of Appeals and Grievance data according to plan business and CMS regulatory technical reporting requirements.
2+ years healthcare appeals & grievances experience, related QA experience, or training/supervisory role.
Appeals Coordinator Jobs
By Anthem Blue Cross and Blue Shield At Norfolk, VA, United States

Experience in a behavioral health setting, managed care experience preferred, UM experience also preferred.

Appeals Nurse Jobs
By Netsmart At United States
At least 3 years of case management, concurrent review or utilization management experience
Prepare professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients.
At least 5 years of clinical experience in acute care setting
Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials.
Bachelor of Science degree in Nursing
Proficiency in medical record review
Hmo Appeals Manager Jobs
By Synergy Healthcare Services, LLC At Maitland, FL, United States

Looking for qualified HMO Appeals Managers to join our team! We are searching for a HMO Appeals Manager to join our community that is a team builder, and excited about the opportunity to assist in ...

Appeals Nurse Jobs
By Mindlance At Ohio, United States
Experience with Utilization Review/Management--2 yrs
Utilization review nurse, appeal review nurse and direct patient care experience.
Share resume at : [email protected]
Behavior and accountability and ability to pivot when new priorities come up
Describe the performance expectations/metrics for this individual and their team:
What previous job titles or background work will in this role?
Nurse Appeals Jobs
By Elevance Health At Ashburn, VA, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Nurse Appeals Jobs
By Elevance Health At Columbus, OH, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Nurse Appeals Jobs
By Elevance Health At Richmond, VA, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Nurse Appeals Jobs
By Elevance Health At Tampa, FL, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Appeals Coordinator Jobs
By Brighton Health Plan Solutions At United States
• Maintain broad knowledge of client products and services
• Strong knowledge of contracts, medical terminology, and claims processing and procedures
• 1+ year computer medical billing or claims adjudication systems experience
• Previous experience handling appeals and grievances
• High School Diploma or GED diploma; some college or business school education is a plus
Company: Brighton Health Plan Solutions
Appeals Coordinator Jobs
By Select Source International At Durham, NC, United States
Demonstrates high degree of appropriate knowledge of all areas of the plan.
Identify and create action plans to educate internal departments on benefit misinterpretation and/or claim payment system errors.
Audit and oversight of entities where delegation of member and provider appeals exists.
Answer member/provider questions via incoming telephone calls in a professional quality driven manner.
May handle complaints/grievances as defined by the federal government.
Appeals Associate - Remote
By Piper Companies At Raleigh, NC, United States
1 - 3 years of experience in claims, customer service, medical office, health insurance or coding experience
Associate degree or higher preferred (HS Diploma considered with relevant experience)
Certified Professional Coder (CPC) certification required
Salary: $22-$25/hr, based on previous experience
Benefits: Medical, Dental, Vision, 401k
Responsibilities of the Appeals Associate:
Member Appeals & Grievances Intake Administrator
By Fallon Health At Worcester, MA, United States
Assigning case files to the department staff for case management.
Responsible for additional clerical/administrative responsibilities at the discretion of the Director or Manager.
Print, mail, and triage letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA.
Managing incoming faxes and member specific data, routing to the appropriate staff member.
Producing, maintaining, and distributing reports/calendars utilized by the team to assist in workload planning.
Processes department incoming/outgoing mail per established workflows in a timely and accurate manner.

Are you looking for a job that will give you the opportunity to make a difference in people's lives? Become an Appeals Specialist and help ensure that individuals and families receive the benefits they need and deserve!

Overview An Appeals Specialist is responsible for providing administrative support to the appeals process. They are responsible for researching and analyzing appeals, preparing and submitting appeals, and providing support to the appeals process. Detailed Job Description An Appeals Specialist is responsible for providing administrative support to the appeals process. This includes researching and analyzing appeals, preparing and submitting appeals, and providing support to the appeals process. The Appeals Specialist is also responsible for ensuring that all appeals are handled in a timely and accurate manner. They must also ensure that all appeals are properly documented and that all necessary information is provided to the appeals committee. Job Skills Required
• Excellent research and analytical skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to manage multiple tasks and prioritize workload
• Knowledge of legal and regulatory requirements
• Knowledge of medical terminology
• Proficiency in Microsoft Office Suite
Job Qualifications
• Bachelor’s degree in a related field
• At least two years of experience in a related field
• Knowledge of medical terminology
• Knowledge of legal and regulatory requirements
• Ability to work independently and as part of a team
Job Knowledge
• Knowledge of medical terminology
• Knowledge of legal and regulatory requirements
• Knowledge of appeals process
• Knowledge of medical coding
Job Experience
• At least two years of experience in a related field
• Experience in medical coding
• Experience in appeals process
Job Responsibilities
• Research and analyze appeals
• Prepare and submit appeals
• Provide support to the appeals process
• Ensure that all appeals are handled in a timely and accurate manner
• Ensure that all appeals are properly documented
• Provide necessary information to the appeals committee
• Monitor appeals process and provide updates as needed
• Maintain records of appeals process