- Catholic Health (Buffalo, NY)
- …identification of root cause and process improvement opportunities to eliminate recurring clinical denials . The position acts as a liaison between front-end ... areas and third party payers in scenarios related to denials and appeals . This position educates all...(3 ) years of experience monitoring, reviewing and appealing clinical denials or relevant experience preferred +… more
- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who...UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of… more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non- Clinical Appeals . + Assisting Supervisor/ Manager as needed with various ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...medical billing and/ or payer experience working with UB04, appeals & denials . + Ability to initiate… more
- AdventHealth (Altamonte Springs, FL)
- …will contribute:** This position is responsible for investigating and appealing post-remit denials for all Inpatient and Outpatient clinical services across the ... will bring to the team:** + Reviewing and appealing denials for all clinical services across the...problems **Preferred Qualifications:** . Master's Preferred . Certified Case Manager (CCM) Preferred . Certified Clinical Documentation… more
- Penn Medicine (Philadelphia, PA)
- …our future each day. Are you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing collection of ... responsible for management of lists and processes related to denials and appeals .Coordinator also prepares quarterly denial...Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required. We… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization/ appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors and/ or ... accurate utilization data in a timely fashion. | Monitors denials as well as all financial metrics associated with...departments. | Develops/validates daily work lists for Utilization and Appeals Manager . | Assist with all insurance… more
- Methodist Health System (Dallas, TX)
- …Of Week :** Mon-Fri **Work Shift :** **Job Description :** Your Job: The Manager of Collections Physician Billing is responsible for overseeing the AR follow up team ... drive performance improvements and meet departmental and organizational goals. The Manager will work closely with various internal and external departments,… more
- Trinity Health (Nampa, ID)
- …and the highest quality of care. We are looking to hire a ** Clinical Resource Manager ** for our Medical Center in Nampa, Idaho ... that can't be beat. **About this position:** As a Clinical Resource Manager you will provide concurrent...by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor… more
- NTT America, Inc. (Plano, TX)
- … to join our team. NTT DATA is seeking to hire a **Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end delivery… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN… more
- Surgery Care Affiliates (Boise, ID)
- …Effectively and independently manages second level reimbursement issues, contracted and non-contracted denials and appeals . + This is a demanding environment, ... by working with insurance providers to resolve issues. + Denials and Claims: + Handle denials and...a patient account representative. + High school graduate. Previous clinical , accounts receivable, medical billing appeals and… more
- Catholic Health Initiatives (Houston, TX)
- …processes concurrent denials that require medical necessity determinations; processes appeals and reconsiderations. Act as a working manager within ... **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM operations within the markets, focusing on effective team… more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… more
- Baptist Memorial (Memphis, TN)
- …extensive knowledge of payer guidelines and BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. + Requires a ... the entire appeal process and determines if escalation to manager or payer is next step to get a...of entry to discharge when responding to technical authorization denials . + Compiles, analyzes, and distributes pertinent clinical… more
- Baptist Memorial (Memphis, TN)
- …extensive knowledge of payer guidelines and BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. + Requires a ... the entire appeal process and determines if escalation to manager or payer is next step to get a...of entry to discharge when responding to technical authorization denials . + Compiles, analyzes, and distributes pertinent clinical… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...limited to the following: accounts receivable days, cash collections, denials , avoidable write-offs, staff productivity and work quality and… more
- Beth Israel Lahey Health (Burlington, MA)
- …availability, and discusses issues with outside auditors and the inpatient coding manager /CDI. Prepares appeals on appropriate cases to ensure proper ... security and integrity of patient information. Manage audits. Oversee appeal of denials . Oversee ROI operations, high volume call center and information request… more
- Cardinal Health (Fresno, CA)
- …denials management by root cause analysis and coaching + Manage all preservice denials and appeals + Monitors, tracks, and analyzes staff productivity + ... in patient access management specifically responsible for authorizations, verification of benefits, denials and/or appeals . + Bachelor's degree in related field,… more
- Covenant Health Inc. (Knoxville, TN)
- …by Forbes as a Best Employer. Position Summary: Responsible for supervision of clinical audit and appeals processes conducted by Revenue Integrity Department ... co-workers to identify process improvement activities and to reduce denials . + Advises, educates, and acts as clinical...Medicaid and other insurance payers as deemed appropriate by manager in relation to denials , audit findings,… more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… more
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