Healthcare Appeals Resolution Specialist

The Clinical Resolution Specialist role at UnitedHealth Group is a vital component of our Prospective Investigations process. The primary responsibility of this position is to review medical records and determine the eligibility of claims for payment. This requires a high level of attention to detail and strong analytical skills to ensure compliance with...

At UnitedHealth Group, we're committed to helping people live healthier lives. As a Recovery Resolutions Representative, you'll play a critical role in ensuring that our members receive the care they need. Your responsibilities will include reviewing medical records, identifying key details, and determining the next steps for claims processing. You'll work...

Unified Women's Healthcare is a leading national platform for women's healthcare, comprised of over 900 care centers and 2,500 affiliates in 19 states. Our affiliate, Midwest Center for Women's Healthcare, is seeking a Full-Time OB/GYN physician for their practice in Park Ridge, IL. This position offers a unique opportunity to join a well-established and...

Paralegal SpecialistBusy Season Staffing Solutions seeks an experienced Paralegal Specialist to support our client legal team. As a Paralegal Specialist, you will assist attorneys in preparing legal documents, conduct research, and manage files and documents. Key responsibilities include:• Document Preparation: Assist attorneys in preparing legal documents...

Job Title: Prior Authorization Specialist IThe Prior Authorization Specialist I is a crucial role at APR Consulting, Inc., where you will be responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government, and other payors across various healthcare...

About the RoleWe are seeking a skilled Healthcare Utilization Specialist to join our team at Elevance Health. This is an exciting opportunity for a motivated and detail-oriented individual to work in a dynamic environment.Job SummaryThe Healthcare Utilization Specialist will be responsible for conducting preauthorization reviews for diagnostic imaging...

Job Summary:Credit & Collections Specialist plays a crucial role in ensuring timely payment of health insurance premiums and claims. This position is responsible for collection activities related to past due health insurance premiums and/or past due health insurance claims.Key Responsibilities:Follow established guidelines to collect past due insurance...

Role OverviewAs a Healthcare Compliance Specialist at Protalents, you will be responsible for conducting onsite reviews of practitioner offices and medical records. Your expertise will be invaluable in identifying improvement opportunities and providing guidance to practitioners on implementing corrective actions.Key ResponsibilitiesConduct onsite reviews of...

Acadia Healthcare is seeking a highly skilled Care Coordinator Specialist to join our team.

Job SummaryWe are seeking a highly skilled Rehabilitation Therapist Specialist to join our team at Acadia Healthcare.

About the roleAbarca Health is seeking a skilled professional to join our PBM Operations & Services team as a Coverage Determination Specialist.The ideal candidate will possess strong analytical skills and the ability to communicate effectively with pharmacists, beneficiaries, and doctors.Responsibilities will include reviewing and responding to coverage...

Optum Collections Representative Job DescriptionAt Optum, we're dedicated to delivering care and improving health outcomes for millions of people worldwide. As a Collections Representative, you'll play a vital role in ensuring the financial well-being of our patients by resolving claims and providing exceptional customer service.Key Responsibilities:Comply...

Job Title: Catheterization Laboratory SpecialistJob Type: Travel Allied Health ProfessionalPRN Healthcare Services is seeking a skilled Catheterization Laboratory Specialist to join their team. The ideal candidate will have experience in catheterization laboratory procedures and a strong understanding of cardiac catheterization techniques.Key...

Purpose: As a key member of the Hospital San Juan Capestrano team, this role is responsible for facilitating effective communication on nursing units, ensuring seamless interactions between staff, patients, and other stakeholders.Key Responsibilities:• Assemble and maintain accurate patient charts for admissions, transfers, and discharges in accordance...

Job Summary:The Medical Support Specialist will coordinate the activities of the nursing staff, patients, physicians, and other hospital departments. This role requires excellent communication and organizational skills to manage supplies and equipment, perform general receptionist and clerical duties, and facilitate the efficient functioning of the nursing...

About the Role:We are seeking a skilled Cardiovascular Diagnostic Specialist to join our team at Garden City Hospital. As a Cardiovascular Diagnostic Specialist, you will assist in the preparation and execution of various cardiovascular procedures.Responsibilities:Assist in the preparation of the procedure room and ensure all necessary equipment and supplies...

Job SummaryAs a key member of the Walgreens pharmacy team, the Pharmacist Healthcare Specialist oversees daily operations, ensuring seamless workflow management, exceptional patient care, and continuous quality improvement. This role requires adherence to company policies, compliance with regulatory bodies, and a strong focus on customer satisfaction.Key...

Product Quality Assurance Specialist Job DescriptionAt Abarca Health, we are igniting a revolution in healthcare by redefining pharmacy benefits. We are seeking a Product Quality Assurance Specialist to join our team. This role will ensure that business requirements are developed accurately and configured into our claims adjudication platform.Key...

Alois Healthcare seeks a skilled Medical Imaging Specialist - CT Technologist to work in Newberg, Oregon. The ideal candidate will have experience operating CT scan equipment, positioning patients, and interpreting physician instructions. Key responsibilities include accurately administering contrast materials, operating the CT scanner, and capturing...

Job Summary: We are seeking a highly skilled Healthcare Talent Acquisition Specialist to join our team at West Suburban Medical Center. This role is responsible for the recruitment and retention of qualified candidates, collaborating with executive leadership to establish effective recruitment strategies and performance expectations.Key...