8 Appeals Process Jobs

Role Overview: As an Authorization Specialist, you will be responsible for reviewing, analyzing, and understanding authorization requests to ensure accuracy and completeness. You will collaborate with internal departments to gather necessary information, verify eligibility and coverage details, and communicate with external stakeholders for necessary approvals. Your role will involve maintaining accurate records, understanding appeal requirements, monitoring industry regulations, providing support to staff, generating reports, and contributing to process improvement. Key Responsibilities: - Review, analyze, and understand authorization requests - Collaborate with internal departments for nec...

As a Quality Analyst, your role involves supporting quality auditing, analysis, reporting, and developing plans to achieve positive outcomes. You will work on risk identification, diagnosing issues, identifying process improvement solutions, and implementing improvement methods. Continuous engagement and collaboration with the Operations and Training Team is essential for success. Key Responsibilities: - Ensure that project-related quality processes are followed by denials analyst and that client-specific and internal metrics are achieved - Prepare detailed reports on audit findings and understand quality requirements from both process and target perspectives, delivering reports in a timely ...

As a Reviewer of Precertification Requests for Medical Necessity, your role involves evaluating requests based on clinical policy guidelines. This includes: - Providing unbiased recommendations on medical necessity by analyzing medical records from requesting parties. - Collaborating with Medical Directors to refer cases that do not meet the established guidelines initially. - Reviewing the appropriate length of hospital stays using Milliman Care Guidelines. - Conducting efficient and timely reviews while adhering to urgent and non-urgent turnaround time standards. - Offering peer-to-peer reviews and participating in the appeals process for case denials. In addition to these responsibilities...

As a Reviewer of Precertification Requests, your role involves evaluating requests for medical necessity based on clinical policy guidelines. Your responsibilities include: - Reviewing precertification requests to determine medical necessity according to established guidelines - Verifying the eligibility and benefits of members" coverage - Communicating effectively with network providers and members to gather additional information as needed - Providing unbiased recommendations based on the medical records provided - Collaborating with Medical Directors to refer cases that do not meet guidelines initially - Assessing the appropriate length of hospital stays using Milliman Care Guidelines - E...

Position: Quality Analyst AR (US Healthcare RCM) Location: Onsite Sector 18, Gurugram Shift: Night Shift (US Hours) Company: Neolytix About Neolytix Neolytix is a trusted provider of business solutions for healthcare organizations across the United States. We specialize in revenue cycle management (RCM), compliance, and business support, helping our clients drive growth, operational efficiency, and financial health. With a 4.7? rating on Google and 4.2? on Glassdoor, we take pride in fostering a workplace that values transparency, learning, and results. Position Overview We are looking for a detail-oriented Quality Analyst AR (Accounts Receivable) to join our RCM team. This role focuses on a...

As an AR caller or Senior AR caller at Shiash Info Solutions, you will be responsible for managing accounts receivable in the US healthcare domain. Your role will involve handling billing for physicians and hospitals in the Chennai office (Work From Office). We are looking for candidates with 1 to 3.5 years of experience in this field, and immediate joiners are preferred. To excel in this role, you must have a minimum of 1 year of experience as an AR caller. Your responsibilities will include understanding medical billing processes, communicating effectively, and negotiating with clients. Attention to detail is crucial, especially in handling denials, revenue cycle management, and the end-to...

Designation: SME - Denial Management Experience: 2-3 years Skills desired: Detailed knowledge of US healthcare billing cycle Experience working with different EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc. Denial analysis and management - Review and analyze denied insurance claims to identify cause of denials such as coding issues, preauthorization, payer-specific policies - Develop and track denial log to monitor patterns and trends in denied claims - Experience talking with payers to obtain clarification with denials and initiate timely appeals when appropriate Expertise in working with denial reason codes (CARC, RARC) and identifying r...

As an AR Caller at our office in Bangalore, you will have the exciting opportunity to utilize your expertise in eClinicalWorks (ECW) software and contribute to the growth of your career in medical billing and revenue cycle management. Your primary responsibility will be to make outbound calls to insurance companies, verify claims, and effectively resolve outstanding balances. Additionally, you will handle denials and rejections, ensuring timely corrections and resubmissions through the use of eClinicalWorks (ECW) software. It will be crucial for you to follow up on unpaid claims, escalate issues when necessary, and ensure prompt collections while maintaining accurate records of claim status,...