- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based on … more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Appeals Quality and Training Specialist supports the Appeals Department. This ... projects. + Independently partners with Medical Directors and other clinical support staff on appeals requiring ...Directors and other clinical support staff on appeals requiring clinical decision-making determinations. + Conducts… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...manner. This position will focus on quality review of non- clinical grievance and appeals cases for all… more
- Healthfirst (FL)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + ... Work within a framework that measures productivity and quality for each Specialist against expectations + Work independently exercising judgment starting the case… more
- Molina Healthcare (Omaha, NE)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... Reporting to the Prior Authorization Superv isor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- State of Colorado (Pueblo, CO)
- Clinical Safety Specialist Supervisor - CSS III- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5088731) Apply Clinical Safety ... in patient-care areas, works with the treatment teams, and assists nursing and clinical staff to ensure a safe and therapeutic environment. This position will assist… more
- State of Colorado (Denver, CO)
- Certified Therapist Recreation Specialist (CTRS) - Clinical Therapist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5082555) Apply ... Certified Therapist Recreation Specialist (CTRS) - Clinical Therapist II Salary...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Hartford HealthCare (Farmington, CT)
- …. Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory ... Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS),and/or Certified Clinical Documentation Specialist … more
- HCA Healthcare (Brentwood, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock… more
- City and County of San Francisco (San Francisco, CA)
- …assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital ... role, you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical /Technical/Service** + Demonstrates the ability to perform clinical… more
- Houston Methodist (Houston, TX)
- …Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial management and appeals process in a ... collaborative environment with revenue cycle management and clinical partners at various Houston Methodist facilities. This position will be responsible for working… more