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Medicare 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.
Medicare Enrollment Specialist - Remote
By ASK Consulting At ,
Ability to pass licensing exam and Carrier certifications annually and maintain good standing
Actively manage all assigned appointments to ensure all retirees needs are met on a timely basis
Deliver a consistently positive customer experience in a highly ethical and professional manner
Expiry Date: 04 September 2023
Meet and/or exceed monthly sales goals and service levels
Handle inbound service calls by providing accurate and complete information via researching/selling/locating licensed agent
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
Medicare Claims Resolution Specialist - Remote -Digitech
By Sarnova At United States
Handle all correspondence via mail, email and any necessary refunds; perform other duties as assigned by management
Strong computer skills. Basic understanding of MS Outlook, Word and Excel.
Experience in an environment where calls were monitored and scored as well as metrics applied to individual performance is helpful.
Excellent communication skills, both written and verbal. Able to present information and solutions in a professional and courteous manner.
Shift M-F 830am-5pm EST. Fully Remote. Work from the comfort of your home.
Review claims that have been put on hold, working to identify causes and address issues causing them to remain on hold
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.
Medicare/Acd Specialist (Rn) - Remote
By Acentra Health At Nashville, TN, United States
Do you value care management and quality improvement?
Knowledge of CMS medical necessity guidelines and benefit coverage criteria strongly preferred.
Are you an experienced Clinical Reviewer looking for a new challenge?
Maintain current knowledge of CMS regulations, guidance documents, and transmittals
Review monthly CPT code report and make suggestions based on the data; review with the Manager prior to meetings
Perform ongoing assessment and maintenance of codes within the ACD and update as appropriate, in collaboration with manager and client
Medicare Risk Adjustment Coding Specialist
By American Health Plans Inc. At Nashville Metropolitan Area, United States
• Escalate appropriate coding audit issues to management as required
• Strong organizational skills; ability to time manage effectively
o 2 years’ experience in managed healthcare environment related to claims and/or coding audits
o Significant HCC experience (including knowledge of HCC mapping and hierarchy)
• Knowledgeable of coding/auditing claims for Medicare and Medicaid plans
• Extensive knowledge of ICD-9 & ICD-10 diagnostic coding and auditing
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.
Appeals Specialist (Medicare Part B) - Palmetto Gba
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
Experience working with Medicare Part B
Prior medical office or insurance experience strongly preferred.
Our Comprehensive Benefits Package Includes
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.
Updates letters and documents within the department when necessary.
Associate Claims Specialist: Medicare (Remote)
By Providence Health Plan At , Beaverton, 97005, Or
Provide and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products
2 years' experience with claims, customer service or accounting
We welcome 100% remote work for residents living within a thirty mile radius of Portland, OR.
Required qualifications for this position include:
Preferred qualifications for this position include:
Check out our benefits page for more information about our Benefits and Rewards.
Review & Appeals Specialist I
By National Commission on Certification of Physician Assistants (NCCPA) At Johns Creek, GA, United States
Your highly developed time management skills, systematic approach to organization/planning and keen attention to detail.
Maintain ongoing knowledge regarding NCCPA organizational policies, departmental policies, standard operating procedures, operational guidelines, business rules, reports and audit tools.
Your proven analytical approach and proactive problem-solving skills that identify and recommend solutions to the determined issues.
Your excellent written and verbal communications skills with a proficiency in diplomacy and confidentiality.
Your proven ability to manage competing priorities and accomplishing tasks within the agreed upon timeframe.
At least two years of professional experience in business, healthcare, appeals & grievances, state medical board or legal field.
Billing/Collection Specialist - Medicare
By Northside Hospital At Atlanta, GA, United States

2023-37541 Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more ...

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.
Rn Specialist-Denials And Appeals
By Ascension At , Batavia, 60510, Il
May educate case management staff and other departments regarding payer changes and denial/appeal process.
Use clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
Collaborate with managed care department to code billable items for reimbursement.
Licensure / Certification / Registration:
Hospital: Alexian Brothers Health System
Establishe and maintain positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines.
Medicare Specialist (Remote) ($53973.00 - $75562.00 / Year)
By Talentify.io At United States
Thorough knowledge of claims management
Compiles, reviews and analyzes claim files and/or management reports.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Excellent oral and written communication, including persuasive writing skills
Strong analytical and interpretive skills
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
Legal Appeals Research Specialist I
By Arkansas Blue Cross and Blue Shield At , Little Rock, Ar
Minimum three (3) years' claims processing or claims research experience.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
High school diploma or equivalent.
Familiarity with CPT, ICD-10 and Medical Terminology
ICD 10 and CPT Coding
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
Medicare Specialist (Remote) Jobs
By Sedgwick At Delaware, United States
Thorough knowledge of claims management
Compiles, reviews and analyzes claim files and/or management reports.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Excellent oral and written communication, including persuasive writing skills
Strong analytical and interpretive skills
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
Medicare Specialist (Remote) Jobs
By Sedgwick At Washington DC-Baltimore Area, United States
Thorough knowledge of claims management
Compiles, reviews and analyzes claim files and/or management reports.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Excellent oral and written communication, including persuasive writing skills
Strong analytical and interpretive skills
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
Hospital Denials/Medical Appeals Specialist
By Beth Israel Lahey Health At , Burlington, Ma
Required Education: High School Diploma
Preferred Licensure, Certification & Registration: Medical Billing Certification
-Bonuses are paid out within the first 30 days of hire.
-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.
Medicare Billing Specialist Jobs
By Home Healthcare, Hospice & Community Services (HCS) At , Remote
Associates degree in accounting or equivalent work experience; Bachelor’s degree preferred
A minimum of two years Medicare billing experience
Working knowledge of accounting principles and Medicare reimbursement system
Review all billing for coding accuracy.
Maintain patient information and make appropriate changes.
Communicate with Medicare, clinical and audit team to promote timely payments.