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Provider Appeals Coordinator Jobs

Authorization Appeals Coordinator Jobs
By Fred Hutch At Seattle, WA, United States
Present denial information to Revenue Cycle Management.
Working knowledge of ICD-10, CPT and HCPS coding
Ability to apply knowledge of commercial payor and regulatory guidelines
Ability to organize and prioritize concurrent responsibilities.
Ability to troubleshoot and offer solutions for process improvement.
Initiates appeals for denied authorization requests.
Appeals And Grievances Coordinator
By Clear Spring Health At Miramar, FL, United States

Candidates should have working knowledge of Medicare and member services or work in a health plan or health plan supprting vendor.

Appeals Coordinator Jobs
By W3R Consulting At Detroit, MI, United States
Preferred Skills/Experience Previous health care or health insurance industry experience
Education/Certifications Bachelor’s Degree in English, Communication, Health Care Administration, or related field
Job Title: Appeals Coordinator- 100% remote
•Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math
•Previous customer service or concierge experience
•Strong PC application and system skills- having the ability to navigate multiple computer systems and databases
Healthcare Appeals/Denials Coordinator - Remote | Wfh
By Get It Recruit - Healthcare At Los Angeles, CA, United States

Are you passionate about making a difference in the healthcare industry? Do you thrive in a dynamic environment where your skills are valued? We are currently seeking a dedicated Healthcare ...

Provider Utilization Coordinator Sr
By QTC Management, Inc. At , San Antonio, 78228 $21 - $23 an hour
Experience utilizing EMR or case management software
Effective management of electronic confirmation systems (i.e. eMessenger, Pega communicator, ACD) in order to minimize no show rates
Excellent data entry and typing skills
Ability to coordinate with regional utilization manager (RUM) on IPA utilization issues
Efficiently utilizes electronic tools and workflows in order to manage resources such as: ECW, UCM, eProcess and other tools as necessary
Excellent communication skills in English, both written and verbal
Coordinator Complaint Appeals Jobs
By CVS Health At , , Ca $17.00 - $27.90 an hour
Research Standard Plan Design or Certification of Coverage (Evidence of Coverage) relevant to the member to determine accuracy/appropriateness of benefit/administrative denial.
Research Standard Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial.
Experience in reading or researching benefit language
Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation requirements.
Excellent verbal and written communication skills
Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics
Provider Grid Operations Coordinator
By ApolloMed At Monterey Park, CA, United States
Detail oriented and have good organizational skills
Environmental Job Requirements and Working Conditions:
Review providers add, termination, and demographic update requests.
Maintain and update providers’ health plan unique identification numbers across all lines of business.
Identify providers’ data error and coordinate with responsible parties to correct.
Accurately log all providers’ requests and be able to provide monthly summary to Director and Team Lead.
Appeals Coordinator Level I
By MedReview Inc. At New York, NY, United States
Manage large volume of documents including faxing, downloading, and uploading from different databases or SFTP
Knowledge of organization of medical records and medical claims terminology preferred
Strong analytical skills with the ability to make timely and sound decisions to meet department standards
Good interpersonal and written/oral communications skills
Performs accurate categorization and appropriate triage upon receipt of each appeal or inquiry
Assures timelines and appropriateness of appeals
Appeals Coordinator - Remote (Ak, Az, Fl, Id, Or, & Wa)
By Moda Health At United States
6 months to 2 years of experience of medical/dental claims processor or customer service preferred.
Demonstrated knowledge of CMS rules for Medicare and Medicaid grievance, complaint and appeal processes preferred.
Knowledge and understanding of complaint and appeal procedures preferred.
Ability to interpret benefit contracts and/or Moda Health administrative policies, products, and business lines.
Demonstrated strong reading, verbal, written and interpersonal communication skills.
Demonstrated initiative, analytical, problem solving, and organizational skills.
Provider Services Coordinator Jobs
By Healthmap Solutions At United States
Associate degree or equivalent combination of education and experience
2 years of administrative experience in the healthcare field
Work from home within commutable range or region, city, or state
Ensure that patients in “Out of Scope” and “Not Participating” practices are appropriately VCT transferred
Assist with PRT account assignments both at launch and ongoing maintenance
Audit records for quality and accuracy, providing documented feedback to department directors
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.

Quality Assurance Specialist - Provider Appeals And Dispute
By Alignment Health At California, United States
Recognize and identifies possible training issues and error trends and reports findings to department management.
Prepares and submits PDR Specialists’ monthly quality performance reports to management.
Prepares and disseminates internal management reports accurately within required timeframes.
Performs additional related duties as assigned by management.
Computer skills: Intermediate to Advance Microsoft Excel and Word; Microsoft Access and EZCAP experience preferred.
3+ years auditing of medical claims or provider dispute experience preferably in health plan setting
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 And Grievance Coordinator
By BroadPath At United States
2+ years of Medicare Appeals/Grievance experience required
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Excellent verbal and written communication skills
However, based on performance BroadPath can offer other opportunities based on availability once the contract ends.
Processing Medicare Appeals/Grievance with Medicare Part C or D experience
Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
Appeals Coordinator - Need Icd-10 Certification
By TalentBridge At Pittsford, NY, United States
Performing other duties as assigned by management
Associate's Degree from an accredited college or university or equivalent experience
At least two (2) years of experience in a medical billing, claims processing, or related position required
Job Duties Include, But Are Not Limited To
Minimum Qualifications for the position:
Review and analyze case file materials that involve claims payment disputes
Provider Integration Coordinator Jobs
By Inova Health System At ,
Experience with provider credentialing and management of the onboarding process
Supports work streams associated with provider integration which may include change management initiatives, system development initiatives, program implementations, etc.
Serves as support for staff and peers for educational and professional skills within the onboarding space.
Draws valid conclusions for recommendation to management for decision making to suggest potential alternatives using data analysis.
Superior Critical Thinking Skills and Ability to take a proactive approach
Supports the effectiveness of each programs processes and timelines, collaboratively working with the Directors of Operation and Hiring Managers.
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
Appeals Paralegal Jobs
By Manhattan District Attorney's Office At New York, NY, United States
Manage federal and state court related caseloads.
Excellent interpersonal, organizational, communication, and writing skills.
Ability to work independently and manage deadlines.
Responsibilities Include But Are Not Limited To
Regularly write an elementary legal brief with a designated attorney.
Maintain and update the Division's digital case tracking system.
Appeals Coordinator Level Ii
By MedReview Inc. At New York, NY, United States
Associates Degree. Additional years of related experience may be used in place of education requirements
Excellent organization and time management skills required
Manage and monitor all appeals from Non-Participating providers
Other duties and responsibilities as assigned
3+ years’ experience working in the health care industry
Experience in inpatient claims, DRG and High-Cost Outlier claims preferred