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Appeals Specialist Jobs

Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Augusta, GA, United States
Excellent organizational, customer service, and written and verbal communication skills.
Proficiency in spelling, punctuation, and grammar skills.
Perform non-medical reviews and process redetermination letters ensuring timeliness and accuracy.
Prepare unit reports, analyze, and interpret workload, and process issues utilizing various software tools.
Update letters and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.
Hospital Denials/Medical Appeals Specialist
By Beth Israel Lahey Health At Burlington, MA, United States
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
Compliance Appeals Specialist, Cash App
By Cash App At Chicago, IL, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
Required Education: High School Diploma or equivalent
Required Work Experience: Two (2) years of job related experience (healthcare, insurance, banking or call center).
Our Comprehensive Benefits Package Includes
Eligible for up to a $2400 annual bonus.
Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
Compliance Appeals Specialist, Cash App
By Cash App At Phoenix, AZ, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Compliance Appeals Specialist, Cash App
By Cash App At New York, NY, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Compliance Appeals Specialist, Cash App
By Cash App At Denver, CO, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Compliance Appeals Specialist, Cash App
By Cash App At Charlotte, NC, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Compliance Appeals Specialist, Cash App
By Cash App At San Francisco, CA, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Compliance Appeals Specialist, Cash App
By Cash App At Atlanta, GA, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Compliance Appeals Specialist, Cash App
By Cash App At Portland, OR, United States
Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work
3+ years experience in BSA/AML or Fraud related work, preferably in the payments space
Strong investigative skills, including familiarity with public record research and database tools
Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios
Proven working experience as a Compliance Specialist
4+ years relevant experience in BSA/AML and Sanctions related work
Grievance & Appeals Quality Assurance Specialist
By SnugZ USA At New York, NY, United States
3 years quality management experience
Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
Update current workflows and draft future workflows, incorporating regulatory requirements, quality, and efficiency within design.
Auditing, researching, analyzing and evaluating grievance and appeals data to assess compliancy between process and the corresponding CMS and DOH regulations.
Coordinate, facilitate and document audit walkthroughs.
Develop training and refresher training.
Appeals Specialist Jobs
By Kepro At Cary, NC, United States
Do you value care management and quality improvement?
Are you an experienced Appeals Specialist looking for a new challenge?
Excellent verbal and written communication skills.
Requires 3+ years’ customer service experience.
Previous experience in the health care industry preferred
Are you motivated, energetic, and excited to become part of the Kepro team?
Appeals & Support Specialist Jobs
By County of Dallas Tax Appraisal District At , Dallas, 75247 $32,000 - $49,653 a year
Previous customer service, appraisal office, or other office experience.
Bilingual in Spanish - (read and speak) is preferred.
Salary Range: $32,000 to $49,653 DOE
Eligibility Appeals Specialist Jobs
By Arizona Healthcare At , $46,000 a year
Knowledge, Skills & Abilities (KSAs):
Use logic, problem solving techniques, and analytical skills
Must have a high school diploma or General Equivalency Diploma (G.E.D) and 3 years of customer service experience.
A top-ranked retirement program with lifetime pension benefits
Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
Defined benefit plan that provides for life-long income upon retirement.
Nurse Appeals (Contract) Jobs
By Elevance Health At , Los Angeles
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.
Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.
Appeals Analyst Jobs
By BlueCross BlueShield of South Carolina At South Carolina, United States
Excellent organizational and time management skills.
Continuing education funds for additional certifications and certification renewal
Two years clinical experience plus one year utilization/medical review, quality assurance, or home health, OR three years clinical.
Working knowledge of word processing software.
Strong clinical experience, including home health, rehabilitation, and broad medical surgical experience.
Knowledge of specific criteria/protocol sets and the use of the same.
Remote Va Appeals Clerk
By Jan Dils, Attorneys at Law At , , Ga $14.62 - $20.24 an hour
Remote Appeals Clerk Benefits include:
Become an expert on our Case Management Software, Adobe, and Microsoft Office that you will be using daily.
Remote Work – No commute – Work from home!
What you will be doing as a Remote Appeals Clerk:
Not only is the position itself great, but the benefits we offer are fantastic as well!
Health, Vision, & Dental Insurance
Appeals Reviewer (Remote) Jobs
By Capitol Bridge At , Remote $55,000 - $66,622 a year
Manage referral caseload and update weekly referral pending report.
At least three years of Medicare review or appeals experience.
Knowledge of Medicare policies and coverage issues and HCPCS coding.
Strong organizational, interpersonal, written, and verbal communication skills.
Conduct research on federal law, regulations, and CMS and contractor policies.
Collaborate with attorneys and the Medical Director to review new or complex issues, when necessary.
Appeals & Grievances Analyst Jobs
By Point32Health At Massachusetts, United States
Review and interpret product and benefit designs for all lines of business according to State and Federal regulatory requirements
Health care benefit and regulatory knowledge preferred
Must be able to work under normal office conditions and in a remote capacity from home as required.
Make recommendations on appeal decisions based on the member’s benefits and individual circumstances presented.
Associates Degree or equivalent experience in health care, conflict resolution or related field
3-5 years health care or insurance experience

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