- Nuvance Health (Danbury, CT)
- …departments, team members, providers, delegates, and community partners. In addition, the Manager Denials Prevention & Appeals Operations is responsible ... coaching and feedback to team members. * Collaborate with Manager Denials Prevention & Appeals ... management into other internal and external teams/departments including Denials Management and Care Coordination * Conduct clinical… more
- Catholic Health (Buffalo, NY)
- …8-4 with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for ... include setting up arbitration between parties. This individual provides clinical oversight to the clinical denials... areas and third-party payers in scenarios related to denials and appeals . This position educates all… more
- Hartford HealthCare (Farmington, CT)
- …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… 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. +...+ 0-2 years medical billing experience working with UB04, appeals & denials . **What Would Be Nice… 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
- CenterWell (Raleigh, NC)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- Garnet Health (Middletown, NY)
- …is responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate ... The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials … more
- McLaren Health Care (Grand Blanc, MI)
- …Doctor of Medicine Degree **.** **4 years of utilization management, case management, clinical documentation, and/or denials / appeals experience in an acute ... tools for reporting trends and identifies opportunities for potential denials management impact on medical necessity and clinical... denials management impact on medical necessity and clinical validation denials and assist with vendor… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion… more
- Amergis (French Camp, CA)
- …have Acute Case Management experience ? Key Responsibilities: + Discharge Planning + Appeals & Denials + Utilization Review + InterQual assessments + ... Salary: $3242 / Week The RN Case Manager is responsible for coordinating continuum of care...Case Management experience + Current Discharge Planning experience + Denials & Appeals experience + Utilization Review… more
- Guthrie (Sayre, PA)
- …and root causes; develop strategies to reduce preventable denials + Ensure appeals are written and submitted timely, with clinical accuracy and regulatory ... Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management...responsible for the oversight and management of all payer denials , appeals , and audit processes within the… more
- NTT DATA North America (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
- HCA Healthcare (Nashville, TN)
- …and expertise! **Job Summary** We are seeking a diligent and experienced Senior Manager , Clinical Review, Quality Control to ensure the quality and accuracy ... compliance team, and enhancing the overall quality of our clinical processes. The Senior Manager will analyze...intervention from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of… more
- Community Health Systems (Franklin, TN)
- …management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating...insurance companies to secure coverage approvals and mitigate concurrent denials by submitting reconsiderations or coordinating peer-to-peer reviews. +… 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
- 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
- Mount Sinai Health System (New York, NY)
- …Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical Record requests ... Clinical /Technical/Service** + Demonstrates the ability to perform clinical /technical/service/administrative tasks: + Prioritizes Insurance Requests / Denials… more
- Bassett Healthcare (Cooperstown, NY)
- …reporting of resources and financial indicators including LOS, excess days, resource utilization, denials and appeals , swing bed statistics. + Uses data to drive ... quality of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in...with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost… more
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