- The LaSalle Group (Evanston, IL)
- …Management team. Thisrole will have a strong focus on resolving complex clinical denials through evidence-based appeals . The Clinical Appeals Specialist will ... State]. Minimum 3 years of experience working with clinical denials and appeals in a hospital or...utilization review and case management principles. Ariel Greene Project Manager LaSalle Network LaSalle Network is an Equal Opportunity… more
- Axsome Therapeutics (New York, NY)
- …and processes (ie, eligibility and benefit verification, prior authorization, and appeals / denials ) supporting patient access to Axsome Therapeutics migraine ... City. About This Role Axsome Therapeutics is seeking a Field Reimbursement Manager (FRM) to collaborate with internal and external stakeholders to eliminate access… more
- Boston Childrens Hospital (Boston, MA)
- …authorizations for the appropriate level of care for admissions and with post-discharge appeals of payer denials . They identify and implement initiatives to ... experience required, pediatric experience preferred. Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
- Northwestern Memorial Healthcare (Chicago, IL)
- …collection of third party payer receivables and tracking of third party yields. Denials and Appeals management including root cause analysis to reduce/prevent ... future denials while working to overturn denials for...any suspected breaches or concerns to the Patient Accounting Manager and Corporate Integrity & Compliance (HIPAA, Patient Privacy,… more
- Lighthouse Autism Center (Mishawaka, IN)
- …helping families arrange payment plans File and assist team members with appeals on authorization denials through third-party billing organization Handle learner ... The Insurance Coordinator reports to the Insurance and Billing Manager and helps our ABA learner families navigate the...intake pipelines with team members Support Insurance and Billing Manager with ad hoc tasks and reports Assists Insurance… more
- Sharp HealthCare (La Mesa, CA)
- …with providers. Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers. Review all ... Nursing -REQUIRED Preferred Qualifications Bachelor's Degree in Nursing Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED… more
- Baptist Memorial Health Care Corporation (Memphis, TN)
- …to send along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be necessary to provide ... the entire appeal process and determines if escalation to manager or payer is next step to get a...BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. Requires a strong… more
- Axsome Therapeutics (Rochester, MI)
- …policies and processes (ie, eligibility and benefit verification, prior-authorization, and appeals / denials ) Maximize use of marketing resources to maintain and ... About This Role Axsome Therapeutics is seeking a Specialty Account Manager (SAM) to execute commercial activities for assigned geographies, establish relationships… more
- BronxCare Health System (Bronx, NY)
- …best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials ... Overview The Appeals Manager is responsible to assist...to assist the department attain its objective of managing denials and appeals . Responsibilities - Types, utilizing… more
- Hartford HealthCare (Farmington, CT)
- …review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... multiple denials , prioritize tasks, and ensure timely submission of appeals . . Experience with electronic health record (EHR) systems, coding software, and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs...Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow… more
- Texas Health Resources (Arlington, TX)
- …Arlington, TX + Core work hours: Monday-Friday 8:00a-5:00p **Summary** The Billing, Coding & Denials Manager will oversee all aspects of claim review and coding ... ** Manager Billing Coding and Denials ** _Are...to issues identified with root cause analysis of the denials and appeals process Manage/Troubleshooting for high… more
- Colorado State University (Fort Collins, CO)
- Posting Detail Information Working TitleInsurance Denials Specialist Position LocationFort Collins, CO Work LocationPosition qualifies for hybrid/in-office work ... and a thriving arts and entertainment industry. Position Summary The Insurance Denials Specialist will provide excellent customer service and guidance to all CSU… more
- CenterWell (Honolulu, HI)
- …responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials . Works with branch staff to gather required ... to develop appropriate and timely responses. + Responsible for constructing response to denials and appeals , utilizing any federal guidelines or local coverage… more
- Corewell Health (Southfield, MI)
- …applying clinical criteria to establish medical necessity. This position reports to the Manager , Denials . + Understands the revenue cycle and the responsibility ... to conduct telephonic or electronic appeals , if applicable. + Elevates appeals to the appropriate manager /committee when necessary. + Provides relevant… more
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… more
- Elevance Health (Irving, TX)
- …additional information if necessary. + Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy. + Ability to ... home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - Paragon Infusion** **Location:** 3033 W President George… more
- Johns Hopkins University (Middle River, MD)
- …issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive ... related to specialized, complex or high-cost procedures. + Contacts providers regarding appeals and medical policy denials , identifies and collects additional… more
- NTT America, Inc. (Plano, TX)
- …and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a **Medicare ... Appeals Clinical Leader** to lead service delivery engagements and...interpret medical records, documenting recommendations to uphold or overturn denials + Excellent analytical and problem-solving skills + Strong… more
- Children's Mercy Kansas City (Kansas City, MO)
- …manages high risk administrative processes and data related to medical necessity denials , clinical appeals , long length of stay rounds, and ... tools and tracking to monitor status and outcomes of denials and appeals to identify trends and...expert at the roles of Clinical Review Nurse Care Manager and Care Coordination Case Manager and… more
