- 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
- CenterWell (Honolulu, HI)
- …responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials . Works with branch staff to gather required ... to develop appropriate and timely responses. + Responsible for constructing response to denials and appeals , utilizing any federal guidelines or local coverage… more
- BronxCare Health System (Bronx, NY)
- …best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials ... and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible...to assist the department attain its objective of managing denials and appeals . Responsibilities - Types, utilizing… more
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… more
- Elevance Health (Irving, TX)
- …additional information if necessary. + Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy. + Ability to ... home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - Paragon Infusion** **Location:** 3033 W President George… more
- Hartford HealthCare (Farmington, CT)
- …(HIM) Clinical Documentation Integrity (CDI) quality, audit, education, and denials prevention program consistent with clinical , regulatory, contractual, and ... Hospital Acquired Conditions (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME)… more
- Genesis Healthcare (York, PA)
- …to reduce AR/DSO and outstanding clinical accounts as needed and generates clinical appeals when necessary. 15. Assists with and completes special projects ... while making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical , administrative, and… more
- LifePoint Health (Rutherfordton, NC)
- …payer guidelines and financial implications of discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. ... **Please select a valid job field* **Organization:** ** **Title:** * Clinical Case Manager * **Location:** *NC-Rutherfordton* **Requisition ID:** *7462-9861* 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
- Children's Mercy Kansas City (Kansas City, MO)
- …Nurse Lead manages high risk administrative processes and data related to medical necessity denials , clinical appeals , long length of stay rounds, and ... tools and tracking to monitor status and outcomes of denials and appeals to identify trends and...Nurse Lead is an expert at the roles of Clinical Review Nurse Care Manager and Care… 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
- Houston Methodist (Houston, TX)
- …services. This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in ... Supervisor. + Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… more
- UNC Health Care (Chapel Hill, NC)
- …to coder questions and provide training and education. This position processes and appeals insurance coding denials . This position analyzes coded records for ... and ancillary cases). 3. Faxes, tracks, and monitors coding denials and appeals on both inpatient and...on both inpatient and outpatient cases. Reviews coding insurance denials and refers clinical coding denials… 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
- 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
- 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
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