- Beth Israel Lahey Health (Burlington, MA)
- …provider escalation grids for submissions monthly or sooner as needed 17. Assists in reviewing appeals compiled by PFS Denial Specialist I to ensure accuracy ... **Work Shift:** Day (United States of America) The PFS Denial Specialist II role is vital to...interprets third party denials. 7. Initiates corrected claims and appeals according to payer guidelines. 8. Responds to incoming… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...Vision, and Values in behaviors, practices, and decisions. Coordinates denial management processes (Clinical and Administrative/Technical accounts, focusing upon… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as an Appeals Specialist ? At Parallon, you come first. HCA Healthcare has committed up ... make a difference. We are looking for a dedicated Appeals Specialist like you to be a... team, validating appeal criteria is met. Compose technical denial arguments for reconsiderations. Identify contract protection to leveraged… more
- Beth Israel Lahey Health (Burlington, MA)
- …interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating ... by management. Analyzes work queues and other system reports and identifies denial /non-payment trends and reports them to the Billing Supervisor. 2. Ability to… more
- Beth Israel Lahey Health (Charlestown, MA)
- …interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating ... by management. Analyzes work queues and other system reports and identifies denial /non-payment trends and reports them to the Billing Supervisor. 2) Ability to… more
- Emanate Health (Covina, CA)
- …care system in the United States, and the #19 ranked company in the country. The Denial Specialist is responsible for denial and AR management as defined by ... Denial Manager. The Denial Specialist will possess and apply thorough...patient account that is involved in the audit and appeals process to accurately complete accounts receivable reconciliation. **Minimum… more
- Abbott (Plano, TX)
- …Our 114,000 colleagues serve people in more than 160 countries. **Sr. Appeals Specialist , Patient Therapy Access Team** **Position Location: 6600 Pinecrest ... **Plano, TX** currently has an opportunity for a **Sr. Appeals Specialist ** . This role is responsible...levels of appeal in the event of initial coverage denial . Manage complex appeals cases for assigned… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after ... physician-to-physician (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial ...conducts appeals , as appropriate. Monitors and tracks denial outcomes with assistance from appeals team,… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials/ appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for A/R, ... Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing...timely to prevent past filing deadlines. * Communicates all denial write offs to Collection Supervisor, and Collections Manger.… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...complaints. 14. Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for division… more
- Logan Health (Kalispell, MT)
- …processing as applicable to assigned area(s). + Responsible for all insurance appeals and works with appropriate stakeholders to ensure completion as applicable to ... assigned area(s). + Serves as point of contact for quotes, equipment authorization, etc. as applicable to assigned area(s). + The above essential functions are representative of major duties of positions in this job classification. Specific duties and… more
- University of Virginia (Charlottesville, VA)
- …policies and guidelines. + Works directly with departments and carriers on denial resolution. + Participates in on-going training to maintain coding certification ... through AAPC. + Other duties as identified by Unit Coordinator, Supervisor and/or Manager. Position Compensation Range: $18.37 - $28.47 Hourly **MINIMUM REQUIREMENTS** Education: High School Diploma or GED Experience: Two years relevant office experience… more
- Molina Healthcare (TX)
- …discussed during our interview process._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions ... for appeals outcomes...and other appropriate criteria with Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management… more
- R1 RCM (Detroit, MI)
- …or government audits. Every day you will provide day-to-day charge review/reporting, denial support, appeals coordination, and reimbursement analysis. To thrive ... As our Revenue Integrity specialist , you will be responsible for key operational...this role, you must have demonstrated ownership of charge, denial , and appeals as it pertains to… more
- Universal Health Services (Tredyffrin, PA)
- …established performance targets (productivity and quality). Initiates and follows-up on appeals . Exercises good judgement in escalating identified denial trends ... - Independence Physician Management - UHS. Position Overview The Accounts Receivable Specialist is responsible for the accurate and timely follow-up of unpaid and… more
- Weill Cornell Medical College (New York, NY)
- Title: Revenue Cycle Specialist -Revenue Integrity Location: Midtown Org Unit: AR - Coding Medicine Work Days: Exemption Status: Non-Exempt Salary Range: $29.15 - ... all documentation standards are met for billing. + Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization. +… more
- Hackensack Meridian Health (Hackensack, NJ)
- …transform healthcare and serve as a leader of positive change. The **Appeal Nurse Specialist ** will be responsible for the timely review and submission of appeals ... level of care change determinations. Gathers and evaluates the information for appeals of Managed Care audits, clinical and technical denials by utilizing various… more
- Fairview Health Services (St. Paul, MN)
- **Overview** The Physician Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the Physician. ... analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge… more
- AvantGarde, LLC (Washington, DC)
- POSITION SUMMARY What a fun job join AG as a Senior Employee Relations Specialist and be the discipline and performance consultant to the Employee Relations Team at ... adverse and performance-based actions, suitability, leave, outside employment, grievances, appeals , and disciplinary actions (letters of counsel, reprimand and or… more
- Beth Israel Lahey Health (Burlington, MA)
- …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands on coding, documentation review and other coding needs ... by management. Analyzes work queues and other system reports and identifies denial /non-payment trends and reports them to the Billing Supervisor. 2. Responds to… more