- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Manager, Denials Prevention & Appeals Operations is responsible for the direct oversight of daily operations of clinical ... stays/days are approved for medical necessity. This position will work closely with the Denials Prevention & Appeals Administration Manager to guide the… 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 , ... related to denial turnaround times, appeal success rates, and denial reduction targets. * Denials Prevention * . Analyze denial patterns to identify root causes… more
- UHS (Binghamton, NY)
- …vital role, you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied ... Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …years of experience in clinical care, utilization review, case management, or clinical denials / appeals -OR- * An approved equivalent combination of ... plays a critical role in reviewing, appealing, and preventing clinical denials related to medical necessity, level-of-care,...to track authorization rules, contacts, and changes supporting a denials prevention program * Collaborate with UM… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial ... and communicating trends and root cause to support future prevention with internal customers and stakeholders as well as...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… 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 ... UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of... clinical information. + Provides oversight of the … more
- CommonSpirit Health (Englewood, CO)
- …and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, crafting compelling appeal ... discuss the needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and… more
- Nuvance Health (Danbury, CT)
- …strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while ... Leader* will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of… more
- Beth Israel Lahey Health (Plymouth, MA)
- …concurrent and retrospective reviews for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors * ... understanding of reimbursement systems. You will manage concurrent reviews, appeal clinical denials , and support accurate level-of-care determinations. Key… more
- Houston Methodist (Houston, TX)
- …services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment. ... also responsible for providing information regarding denial trends for future prevention . **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with management to reduce… more
- Trinity Health (Livonia, MI)
- …and identification of denials ' root cause and initiates resolutions for denial prevention . May assist PFS with complex denial appeals . Works with PFS and ... coordination with the Patient Financial Service (PFS) center, including complex case denials , denial prevention , audits, and educating and training of… more
- HCA Healthcare (San Antonio, TX)
- …medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge ... managers and hospital staff in the reduction of payer denials and in the denial and appeals ...for evidence-based clinical practice, patient safety, and clinical loss prevention to facility leadership and… more
- AdventHealth (Tampa, FL)
- …claim denials to perform the appropriate resolution, rebilling, and/or appeals steps. Assists with developing and implementing strategies and procedures to ... AdventHealth Pepin Heart Institute, a recognized leader in cardiovascular disease prevention , diagnosis, treatment and leading-edge research caring for Tampa Bays… more
- AdventHealth (Tampa, FL)
- …AdventHealth Pepin Heart Institute, a recognized leader in cardiovascular disease prevention , diagnosis, treatment and leading-edge research caring for Tampa Bays ... Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine,… more