Claims & Appeals Specialist II
Driscoll Health —Corpus Christi, TX
- Full-time
- Research
- Mid-level
- 3 years
Policy Management ERM Specialist
CONTINENTAL SERVICE GROUP LLC —Fairport, NY
- $62,353.20 - $71,706.18 a year
- 8 hour shift
- Microsoft Word
- Microsoft Excel
- Mid-level
Quick Apply
Senior Sales Leader | Divisional Growth Specialist
Printville —Bristol, VA
- $45,778.44 - $55,131.02 a year
- Full-time
- Background check
- 3 years
- Analysis skills
- 401(k)
- Paid time off
Quick Apply
Medical Specialist 2 (Doctor; MD)
Sunmount DDSOO —Tupper Lake, NY
- $237,121 a year
- Part-time
- Hybrid work
- Background check
- Medicine
- Management
- Health savings account
- Health insurance
Quick Apply
Mobile Crisis Licensed Qualified Professional
Therapeutic Alternatives —Raleigh, NC
- $45,150 - $48,300 a year
- Full-time
- Experience working with individuals with developmental disabilities
- Nursing
- Addiction Medicine
Contract Senior Vendor Specialist
Manpower —Milwaukee, WI
- $58,303.63 - $70,215.12 a year
- Contract
- Research
- Office
- In-person
Quick Apply
Loan Resolution Specialist
AMIP Management —Lake Forest, CA
- $75,000 - $100,000 a year
- Full-time
- Background check
- 7 years
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Licensed Customs Broker & Contract Compliance Specialist
MRCOOL, LLC —Hickory, KY
- Temporary
- 5 years
- Office
- In-person
Quick Apply
Engineer Specialist, System Planning
Enbridge —Salt Lake City, UT
- Full-time
- Hybrid work
- 7 years
- Engineering
- System design
- Wellness program
- Paid parental leave
1d
Contracts & Business Risk Specialist
IRWIN SEATING COMPANY —Grand Rapids, MI
- Mid-level
- Office
- 3 years
Quick Apply
3d
Civil Construction & Concrete Quality Assurance Specialist - Project Based
Kwest Group —Austin, TX
- $100,000 a year
- Weekends as needed
- Clean driving record
- Heavy lifting
- Pass drug screening
- Employee stock ownership plan
Quick Apply
Professional Land Surveyor, PLS In-Office (10 years Experience Required)
JSD Professional Services, Inc —Madison, WI
- $70,000 - $100,000 a year
- Extended hours
- Civil engineering
- Research
- Office
- Health savings account
- Health insurance
Quick Apply
Rochester Men's Client Care Specialist
MN Adult & Teen Challenge —Rochester, MN
- $19 an hour
- 8 hour shift
- Clean driving record
- Vital signs
- Addiction Medicine
- Health savings account
- Disability insurance
Wellness Specialist/Exercise Physiologist - Garrochales & Aguadilla, PR
WORKCARE INC —Aguadilla, PR
- $33 - $39 an hour
- Full-time
- Spanish
- HIPAA
- English
- Wellness program
- Health savings account
Quick Apply
Clubhouse Employment Specialist
Scranton Counseling Center —Scranton, PA
- Full-time
- Background check
- Psychiatry
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Safety Specialist II (2070)
Osmose Utilities Services —California
- $65,792.02 - $79,233.39 a year
- Weekends as needed
- Microsoft Word
- Background check
- Construction site
- Mileage reimbursement
- Health savings account
Health Information Specialist & HIPAA Privacy Officer
Hometown Health Centers —Schenectady, NY
- $68,000 - $78,000 a year
- Full-time
- Background check
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Cargo Charter Specialist
National Air Cargo —Houston, TX
- $85,000 - $120,000 a year
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
10d
Licensed Mental Health Professional- JBCT
MEDIKO INC —Redding, CA
- $51 - $61 an hour
- Full-time
- CPR Certification
- Nursing
- BLS Certification
- Wellness program
- Health savings account
Quick Apply
Wellness Specialist/Exercise Physiologist - Riverton, WY
WORKCARE INC —Riverton, WY
- $33 - $39 an hour
- Full-time
- HIPAA
- Mid-level
- Office
- Wellness program
- Health savings account
Quick Apply

I want to receive the latest job alert for contracts oversight specialist

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

contracts oversight specialist jobs near

Claims & Appeals Specialist II

Driscoll Health -
Corpus Christi, TX

Apply Now

Job Details

Full-time

Qualifications

Appeals
Process audits
Medical Coding Certification
Maintaining patient confidentiality
Research
Mid-level
3 years
High school diploma or GED
Retrospective medical coding audits
Medical insurance appeals management
Trade school
Healthcare fraud detection compliance audits
Acute care experience
Insurance claims auditing
Insurance claims fraud prevention
Associate's degree
Healthcare claims compliance audits
Insurance claims appeal handling
Medical record review for billing accuracy

Full Job Description

Where compassion meets innovation and technology and our employees are family.

Thank you for your interest in joining our team! Please review the job information below.

Candidates must be able to work on-site. This position is not remote.

GENERAL P URPOSE OF J OB :
The Claims and Appeals Specialist II is a certified medical coder that performs audits for correct coding and claims payments and oversees the claims appeal process for provider and member appeals. This position also investigates Coordination of Benefit (COB) claims. The Claims and Appeals Specialist II reports to the Director of Claims Oversight.

E SSENTIAL D UTIES AND R ESPONSIBILITIES :
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive;
employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

General Duties:

Maintains the utmost level of confidentiality at all times.
Adheres to hospital and DHP policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Performs other duties as requested.
Claims and Appeals Specialist II Duties and Responsibilities:
Reviews claims appeal and makes recommendations regarding reprocessing/denial of payment.
Research provider’s claims questions.
Works closely with Provider Relations Representatives to assist with provider claim issues.
Provides insight to potential claims payment issues.
Notifies Compliance Officer for DHP of potential fraud and abuse.
Research billing issues.
Responds to providers regarding claims-related issues.
coordination of benefit activities.
Coordinates re-consideration of claims with DHP’s Third Party Claims Administrator
Active member of bi-weekly claims meetings between DHP and DHP’s Third Party Claims Administrator.

E DUCATION AND / OR E XPERIENCE :

High school diploma or general education degree (GED); or associate’s degree (A. A.) or equivalent from two-year college or technical school; three to five years related experience and/or training; or equivalent combination of education and experience.
3 -5 years’ experience of coding in an acute care hospital setting preferred

Apply Now

Refine Your Search

contracts oversight specialist jobs

Claims & Appeals Specialist II

Policy Management ERM Specialist

Senior Sales Leader | Divisional Growth Specialist

Medical Specialist 2 (Doctor; MD)

Mobile Crisis Licensed Qualified Professional

Contract Senior Vendor Specialist

Loan Resolution Specialist

Licensed Customs Broker & Contract Compliance Specialist

Engineer Specialist, System Planning

Contracts & Business Risk Specialist

Civil Construction & Concrete Quality Assurance Specialist - Project Based

Professional Land Surveyor, PLS In-Office (10 years Experience Required)

Rochester Men's Client Care Specialist

Wellness Specialist/Exercise Physiologist - Garrochales & Aguadilla, PR

Clubhouse Employment Specialist

Safety Specialist II (2070)

Health Information Specialist & HIPAA Privacy Officer

Cargo Charter Specialist

Licensed Mental Health Professional- JBCT

Wellness Specialist/Exercise Physiologist - Riverton, WY

I want to receive the latest job alert for contracts oversight specialist

Related Searches

Explore jobs in more locations

Where compassion meets innovation and technology and our employees are family.

Job Seeker Tools

Employer Tools

Browse

Stay Connected