Register
Recruit Create CV

Provider Appeals Coordinator Jobs in California

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 ...

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.
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