- NCH Healthcare System (Estero, FL)
- …the clinical information necessary for the appeals process of cases for which a denial of care or services has been received. . Proactively prevent medical necessity ... denials by providing education to physicians, staff and patients, interfacing with payers and documenting relevant information. . Participate in the development of performance improvement activities relevant to identified opportunities. . Actively collaborates… more
- Appcast (Canton, MA)
- …assure that appropriate medical necessity language is clearly defined in the denial letter.Communicates frequently through the day with in network and non-network ... physicians, practices, facilities and/or allied health providers.Communicates frequently through the day with members and other external customers (agents acting on behalf of the provider or member or both) regarding the rational for a determination, as well… more
- Vivian (Nacogdoches, TX)
- …of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, ... readmission prevention and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation… more
- Health eCareers (Stafford Township, NJ)
- …of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate ... physician coding and documentation requirements.Qualifications MD/DO degree from a recognized Medical or Osteopathic SchoolObtain or have the ability to obtain a New Jersey Medical License1-2+ years of experience as a Physician Advisor or similar roleAbility… more
- UHS (Wayne, PA)
- …Initiates and follows-up on appeals. Exercises good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedites ... clear understanding of encounter status Identifies root causes and denial trends and makes recommendations to department leadership to...LCD's and NCD's to help determine root cause for denial trends. As a last resort after exhausting all… more
- Stones Gambling Hall (Citrus Heights, CA)
- …Citrus Heights Municipal Code Chapter 10, Article II, Sec. 10-34. - Issuance or denial of employee permit. (a) Upon receipt of an application for an employee permit ... evaluate the rehabilitation of a person when considering the denial of a license under Penal Code | 4852.05....GAMBLING CONTROL COMMISSION. 12105. Mandatory and discretionary grounds for denial of work permit (a) An application for a… more
- State of Pennsylvania (Harrisburg, PA)
- …issues; draft technical deficiency letters; and make recommendations for approval or denial . Levels of Performance Select the Level of Performance that best ... issues; drafting technical deficiency letters; and making recommendations for approval or denial . B. I have experience reviewing permits and plans to ensure… more
- Surgery Partners (Addison, TX)
- …and /or various committees Ability to effectively present information regarding denial trends, and present to management Ability to read, understand, interpret ... and resolve payer denials and EOB's Understanding of copays, coinsurance, deductibles, and denial codes Ensure denial reviews, claim follow-ups are conducted in… more
- TalentBurst, Inc. (Livermore, CA)
- …this role, you will handle and resolve all insurance follow up and denial issues to ensure that company receives correct reimbursements from the insurance companies. ... this role, you will handle and resolve all insurance follow up and denial issues to ensure that company receives correct reimbursements from the insurance companies.… more
- Gastro Health (Miami, FL)
- …correspondence. Updates patient account information Monitors and identifies payer denial trends and problem accounts; communicates patterns to supervisor. Runs ... accounts according to company's policies and procedures. Report any coding related denial to the Coding Specialist. Performs other duties including but limited to… more
- Tenet Health (Goodyear, AZ)
- …utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all ... of services including: *Utilization Management supporting medical necessity and denial prevention *Transition Management promoting appropriate length of stay,… more
- SERV Behavioral Health System (Trenton, NJ)
- …Specialist will follow-up on unpaid claims including denied and held claims, denial review and resolution, corrected claims, denial appeals, payment posting ... as requested, contractual write offs and other adjustments, secondary billing. ESSENTIAL DUTIES & RESPONSIBILITIES: Acute attention to detail with excellent verbal and written communication skills. Intermediate MS Office (Word & Excel) skills is highly… more
- Commure Athelas (Mountain View, CA)
- …the claims lifecycle from post-submission to resolution, with an emphasis on denial trends. Design and implement scalable solutions that reduce friction and revenue ... to improve operational efficiency. Own Key Operational Metrics : Manage throughput, denial rates, and other key metrics for high-profile client accounts. Use data… more
- AmeriHealth Caritas Health Plan (Wilmington, DE)
- …determinations effectively, providing clear, evidence-based rationales for approval or denial decisions Identify and escalate complex cases requiring physician ... review or additional intervention Ensure compliance with Medicaid industry standards Maintain productivity and efficiency by meeting established performance metrics, turnaround times, and quality standards in a high-volume environment Education and Experience… more
- Amentum (Washington, DC)
- …response in writing or verbally, to recommend adjudication as to the approval, denial , or revocation of security clearances and / or access authorizations for ... develop investigative leads; to propose a recommendation as to the approval, denial , or revocation of security clearances. Desired Qualifications: Advanced degree in… more
- Banc of California (Santa Ana, CA)
- …over), ancestry, color, religious creed (including religious dress and grooming practices), denial of Family and Medical Care Leave, disability (mental and physical) ... including HIV and AIDS, marital status, medical condition (cancer and genetic characteristics), genetic information, military and veteran status, national origin (including language use restrictions), race, sex (which includes pregnancy, childbirth,… more
- Live Nation Entertainment, Inc. (Wantagh, NY)
- …religious dress and grooming practices), family and medical care leave or the denial of family and medical care leave, mental or physical disability (including HIV ... and AIDS), marital status, domestic partner status, medical condition (including cancer and genetic characteristics), genetic information, military and veteran status, political affiliation, national origin (including language use restrictions), citizenship,… more
- Live Nation Entertainment, Inc. (Minneapolis, MN)
- …religious dress and grooming practices), family and medical care leave or the denial of family and medical care leave, mental or physical disability (including HIV ... and AIDS), marital status, domestic partner status, medical condition (including cancer and genetic characteristics), genetic information, military and veteran status, political affiliation, national origin (including language use restrictions), citizenship,… more
- Molina Healthcare (Long Beach, CA)
- …as required. Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration. Uses motivational interviewing and ... Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns. Identifies… more
- Live Nation Entertainment, Inc. (Brooklyn, NY)
- …religious dress and grooming practices), family and medical care leave or the denial of family and medical care leave, mental or physical disability (including HIV ... and AIDS), marital status, domestic partner status, medical condition (including cancer and genetic characteristics), genetic information, military and veteran status, political affiliation, national origin (including language use restrictions), citizenship,… more
