- Trinity Health (Farmington Hills, MI)
- …Responsible for reviewing all post-billed denials (inclusive of clinical denials ) for medical necessity and appealing them based upon clinical ... Payment Resolution with communication and follow-up processes related to rejections, denials and appeals , ensuring that such activities are tracked,… more
- Trinity Health (Farmington Hills, MI)
- …activities as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and ... Performs day-to- day payment resolution activities within the Hospital and/or Medical Group revenue operations ($3-5B NPR) for an assigned Patient Business… more
- Sanford Health (Sioux Falls, SD)
- …of documentation, interpretation of policies, and handling of correspondence related to denials and appeals submitted by providers and members. Must administer ... a demonstrated understanding of regulatory requirements and timeframes. Intake and coordinate appeals and denials , and then make determinations based on member… more
- Trinity Health (Farmington Hills, MI)
- …Remote Position (Pay Range: $20.6822-$31.0233) Responsible for reviewing all post-billed denials (inclusive of coding-related denials ) for coding accuracy and ... them based upon coding expertise and coding judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS)… more
- Trinity Health (Farmington Hills, MI)
- …Maintains knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues ... day-to- day payment resolution activities within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of an assigned...location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials ). Serves as… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** +...various sources ( medical records, claims data, payer medical policies, etc.), determines the causes for denials… more
- Robert Half Accountemps (Cincinnati, OH)
- …We are offering a unique opportunity in the healthcare industry for a Denials Specialist located in Cincinnati, Ohio. This role involves reviewing and ... * Minimum of 3 years of experience as a Denials Specialist or in a similar role... * Ability to write effective appeal letters for medical appeals * Strong understanding of … more
- University of Utah (Salt Lake City, UT)
- …**Requisition Number** PRN38907B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E ... of U Health - Academics **Department** 00209 - Univ Medical Billing - Oper **Location** Other **City** Other **Type...knowledge of revenue cycle. + Working knowledge of insurance denials , appeals and expected reimbursement rates. +… more
- Universal Health Services (Richmond, VA)
- …The Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist . The Senior Appeals Specialist ... billing of claims and the follow-up on the clinical appeals performed by the facilities. Key Responsibilities include: +...Competitive Compensation & Generous Paid Time Off + Excellent Medical , Dental, Vision and Prescription Drug Plans + 401(K)… more
- Universal Health Services (Bonham, TX)
- …TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare ... payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety… more
- SSM Health (MO)
- …Responsibilities and Requirements:** Job Description PRIMARY RESPONSIBILITIES + Composes DRG/APC appeals based on medical record documentation, coding guidelines ... seeking a highly skilled and detail-oriented Coder for Hospital Denials to join our team at SSM Health. You...at SSM Health. You will be responsible for reviewing medical records and accurately coding diagnoses and procedures for… 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...reflect the standard of care, as defined by the medical staff and the organization; utilizes clinical knowledge and… more
- St. Luke's University Health Network (Allentown, PA)
- …for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding ... related claim denials for professional services, FQHC, MSO, and ASCs across...documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process.… more
- University of Virginia (Charlottesville, VA)
- …analyzes accounts receivable and takes appropriate action to resolve coding and global denials . + Posts denials /rejects into EPIC billing system. + Works complex ... required. Experience in insurance field preferred. Experience utilizing EPIC or other medical billing system required. Licensure: CPC required or two years of… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits...resolution. Engages the coding follow up team for any medical necessity or coding related appeals . +… more
- Johns Hopkins University (Baltimore, MD)
- …resolve issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials , and provides appropriate ... We are seeking a **_PB_** **_AR Revenue Cycle Specialist III_** responsible for the collection of unpaid...specialized, complex or high-cost procedures. + Contacts providers regarding appeals and medical policy denials ,… more
- Hartford HealthCare (Farmington, CT)
- …and homecare to insure optimal revenue cycle performance. The AR Follow Up & Denials Specialist is responsible for resolving unpaid third party balances on $550 ... million in active inventory and $70 million in denials through account follow up, appeals and...management or finance. *Experience* . Minimal: 2 -4 years medical billing and/or accounts receivables experience in a facility… more
- Hackensack Meridian Health (Hackensack, NJ)
- …information for appeals of Managed Care audits, clinical and technical denials by utilizing various Epic and legacy systems for Hackensack Meridian Health (HMH) ... as a leader of positive change. The **Appeal Nurse Specialist ** will be responsible for the timely review and...Facilitates payer audit requests, ie Equiclaim, RAC, etc. for medical necessity denials . + Participate in all… more
- Johns Hopkins University (Middle River, MD)
- …expedite payments. The AR Revenue Cycle Specialist II will research and interpret medical policies regarding denials based on medical necessity. Will use ... + Resolves claim edits. + Drafts and resolves non-standard appeals . + Research medical policies to resolve denials based on medical necessity. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. ... **Work Shift:** Day (United States of America) The Billing Specialist role specializes in high dollar claims, aged claims...complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims… more