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Healthcare Claims Appeals Specialist Jobs

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.
Claims Specialist - Healthcare
By Talently Recruiting At Illinois, United States
Prepare reports for management by collecting, analyzing, and summarizing claim information.
Maintain proper file documentation of assigned files by complying with company and state requirements.
2+ years of experience in the legal or medical field.
Experience with Professional Liability preferred.
Responsibilities include, but are not limited to:
Actively engage in review processes to evaluate liability, assess case value, and oversee reserving functions and total claims costs.
Claims Auditor & Appeals Processor
By Planstin Administration At St George, UT, United States
Provide regular feedback to Claims Management concerning process improvement and/or training opportunities.
Provide regular feedback to Finance.
Knowledge and understanding of medical terminology, anatomy and both ICD-10 and CPT coding.
One or more years of experience working with insurance plans or self-funded options.
Two years' experience in medical claims processing.
Read and interpret Planstin plans to ensure payment accuracy.
Appeals Specialist - Cgs Administrators
By BlueCross BlueShield of South Carolina At Knoxville Metropolitan Area, United States
Two years of job experience in a related field.
Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.
Medical claims processing, appeals, billing, or coding experience.
Our Comprehensive Benefits Package Includes
Work hours during training: 7:30 am to 4:00 pm CT Monday through Friday
Work hours following training: You can start your eight-hour shift between the hours of 5:00 am and 9:00 am CT.
Healthcare Claims Specialist Jobs
By Health Advocate At , Remote From $20 an hour
Exercise exceptional customer service skills in an effort to optimize each contact with the member
Minimum of one year customer service, healthcare, or claims processing experience required.
Basic Knowledge of MS Word and Excel required
Group Benefits (Fully Insured vs. Self-Insured)
Medical Benefits (CDHP/HDHP, PPO, POS, and HMO Plans)
Ability to interpret Explanation of Benefits (EOBs).
Expedited Appeals Specialist- Remote
By ConnectiCare At , New York, Ny $72,000 - $138,000 a year
Relevant Work Experience, Knowledge, Skills, and Abilities
Extensive knowledge and experience in claims, enrollment, benefits, and member contracts. (R)
Excellent prioritizing, organizing, time management, problem solving and analytical skills. (R)
Provide recommendations to management regarding issue resolution, root cause analysis and best practices.
Additional related experience/specialized training may be considered in lieu of degree requirements. (R)
Exceed median production and compliance standards for both case resolution and data requirements.
Provider Non-Contracted Appeals And Claims Analyst
By Mediant Health Resources At Los Angeles, CA, United States
Proven problem-solving skills and ability to translate knowledge to the department
3+ years’ experience processing Medicare Advantage provider appeals from all types of providers (hospitals, physicians, ancillary)
3+ years’ experience in examining all types of medical claims, preferably Medicare Advantage claims
Working knowledge of claims processing systems (EZCAP preferred)
Working knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
Familiarity with billing and coding edits, coordination of benefits, MA Organization, Determination, Appeals and Grievance procedures
Medicare Appeals Specialist Jobs
By BioTAB Healthcare At Maryland Heights, MO, United States
Minimum Qualifications (Knowledge, Skills, And Abilities)
Must have good computer skills, experience with Microsoft Office, required
Use persuasive communication skills to draft appeals and effectively overturn denied or underpaid claims
Researches and monitors issues related to trends that generate cases. Recommends revisions to Revenue Cycle Manager
Experience with Medicare, appeals, denials and processes, minimum 2 years required
Experience in medical device billing and/or general healthcare reimbursement, minimum 2 years required
Assoc Specialist, Appeals & Grievances
By Molina Healthcare At United States
Strong verbal and written communication skills.
Enters denials and requests for appeal into information system and prepares documentation for further review.
Research issues utilizing systems and other available resources.
Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.
Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.
Determines appropriate language for letters and prepare responses to appeals and grievances.
Grievances And Appeals Specialist
By Papa At United States
Ability to work under pressure and within time constraints – excellent time management and prioritization skills are needed.
Intake and management of complex complaints from senior citizens from multiple categories including safety.
Coordinates additional follow up outreach as needed to conclude an investigation and will ensure appropriate departmental communication with managers.
Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.
Strong written and verbal communication skills and an ability to work with people from diverse backgrounds displaying compassion, empathy and understanding.
1 year of Grievance and appeals experienced preferred
Claims Processing Specialist / Healthcare Medical Claims
By Charter Global At United States
Job Title: Client Relationship Manager / Medical Claims Processing
Job Location: Baltimore, MD (Remote)
Job Duration: 10 Months CTH
5 years with medical customer service involvement
1-2 medical claims processing background
Do not need a Salesperson here, need a customer engineer background with Healthcare claims is a must
Medical Insurance Appeals / Claims Follow-Up Specialist (On-Site)
By Denials Management Inc. At Salt Lake City, UT, United States
Bachelor's Degree in Healthcare Administration, Business Management, or related field
In-depth knowledge of medical insurance policies and coverage requirements
Manage and monitor the appeals and claims follow-up process, ensuring that deadlines are met and all necessary paperwork is filed
Analyze policy benefits and coverage to identify and address any deficiencies
At least 3 years of experience in medical insurance appeals and claims follow-ups
Strong communication and interpersonal skills
Appeals Specialist - Remote ($100800.00 / Year)
By Talentify.io At United States
Identify trends noted through appeal reviews and communicate trends to Management team for addition developmental opportunities for staff
Review appealed claims in accordance with appropriate plan/policy provisions
Develop and implement action plans for handling appealed claims which will involve with external communication with attorneys, providers and/or employers
Use tolling and extensions when appropriate during appeal reviews
Determine appropriate type of specialty review required and develop specific questions to be addressed to render an accurate appeal decision
Resolve appeals timely (within mandated timeframes) and communicate appeal outcomes to appropriate parties
Healthcare Claims Denials And Appeals Specialist
By CenterWell Senior Primary Care At Marietta, GA, United States
Minimum of two years medical claims processing experience
Knowledge of healthcare collection procedures and microcomputer software/hardware
Effective analytical and communication skills
Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.
Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.
Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.
Healthcare Claims Specialist Jobs
By LogixHealth At Bedford, MA, United States
A well-rounded knowledge of insurance payers
Prior word processing, spreadsheet and internet software experience including proficiency with MS Teams, Word, Excel, and Outlook
One to two years related experience
Review, organize, and file IDR emails and complete responses
Monitor and track fee requests from arbitrators, and compile and send supporting documentation to arbitrator
Sort and file Good Faith negotiations and respond to carrier and/or arbitrator inquires
Appeals/Grievances Manager - Healthcare (100K)
By Confidential At United States
Bachelors preferred; some health care or product development experience can be used in lieu of the education requirement.
5 years of managed care experience specifically in Complaints, Appeals and Grievances
Experience identifying key metrics and cross-walking requirements
Translate product strategy into detailed requirements and roadmap
Maintain current subject matter expertise in relevant regulatory requirements
Manage within the organization, supervising up to five (5) Product members on day to day operations
Medical Claims And Appeals Examiner
By Fortuna BMC At Sacramento, CA, United States
Provide clerical support to management as needed
Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the job
Verify recipient eligibility and benefits, revenue, and ICD-9 codes
Specific level of software skills as required by the work unit
Must have excellent problem-solving skills
Good verbal and written communication skills

Are you looking for an exciting opportunity to make a difference in the healthcare industry? We are seeking a Healthcare Claims Appeals Specialist to join our team and help ensure that our clients receive the best possible care. As a Claims Appeals Specialist, you will be responsible for reviewing and resolving denied claims, communicating with insurance companies, and providing guidance to our clients. If you have a passion for helping others and a commitment to excellence, this could be the perfect job for you!

Overview:

A Healthcare Claims Appeals Specialist is responsible for reviewing and processing appeals related to healthcare claims. They must be knowledgeable in healthcare regulations and policies, and must be able to interpret and apply them to appeals. They must also be able to effectively communicate with providers, patients, and other stakeholders.

Detailed Job Description:

A Healthcare Claims Appeals Specialist is responsible for reviewing and processing appeals related to healthcare claims. They must be knowledgeable in healthcare regulations and policies, and must be able to interpret and apply them to appeals. They must also be able to effectively communicate with providers, patients, and other stakeholders. They must be able to review and analyze medical records, claims, and other documents to determine the validity of the appeal. They must also be able to make decisions regarding the appeal and communicate the decision to the appropriate parties.

What is Healthcare Claims Appeals Specialist Job Skills Required?

• Knowledge of healthcare regulations and policies
• Ability to interpret and apply regulations and policies to appeals
• Ability to review and analyze medical records, claims, and other documents
• Ability to make decisions regarding appeals
• Effective communication skills
• Organizational skills
• Problem-solving skills

What is Healthcare Claims Appeals Specialist Job Qualifications?

• Bachelor’s degree in healthcare administration, business administration, or a related field
• At least 2 years of experience in healthcare claims processing
• Knowledge of healthcare regulations and policies
• Ability to interpret and apply regulations and policies to appeals
• Ability to review and analyze medical records, claims, and other documents
• Ability to make decisions regarding appeals
• Effective communication skills
• Organizational skills
• Problem-solving skills

What is Healthcare Claims Appeals Specialist Job Knowledge?

• Knowledge of healthcare regulations and policies
• Knowledge of medical terminology
• Knowledge of medical coding
• Knowledge of healthcare claims processing
• Knowledge of appeals process

What is Healthcare Claims Appeals Specialist Job Experience?

• At least 2 years of experience in healthcare claims processing
• Experience in appeals processing
• Experience in customer service

What is Healthcare Claims Appeals Specialist Job Responsibilities?

• Review and process appeals related to healthcare claims
• Interpret and apply healthcare regulations and policies to appeals
• Review and analyze medical records, claims, and other documents
• Make decisions regarding appeals
• Communicate decisions to providers, patients, and other stakeholders
• Ensure compliance with healthcare regulations and policies
• Provide customer service to providers, patients, and other stakeholders