- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely ... remote. The Clinical Denials Prevention & Appeals Specialist plays a critical role in optimizing the revenue cycle and supporting accurate reimbursement for… more
- HCA Healthcare (Brentwood, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock your… more
- Cognizant (Phoenix, AZ)
- …advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, medical necessity,… 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 ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to...including but not limited to: DRG downgrade, DRG Validation, Clinical Validation, diagnosis codes not supported, and/or general coding… more
- Northwell Health (Melville, NY)
- …utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and...3-5 years experience in Utilization Review, Case Management, and Clinical Appeals. 3-5 years of acute inpatient clinical… more
- 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, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- Houston Methodist (Sugar Land, TX)
- …DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information ... opportunities to both operational and clinical stakeholders. The Senior Denials Management Specialist position collaborates with physicians, case managers,… more
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... payers to successfully clear front end claim edits, appeal clinical denials , and address customer service inquiries....of the following: + * CCS - Certified Coding Specialist (AHIMA) + * CPC - Certified Professional Coder… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials ... and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record… more
- Syracuse Community Health Center (Syracuse, NY)
- POSITION SUMMARY: The denials management specialist role involves analyzing, resolving, and preventing denied insurance claims within the Epic electronic health ... healthcare billing, coding, and insurance policies to identify root causes of denials , appeal incorrect decisions, and implement strategies to minimize future … more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a detail-driven Denials Recovery Specialist to join our Revenue Cycle team. In this role, you will ... peace of mind. You'll collaborate with payers, providers, and internal teams to turn denials into resolved claims and confusion into clarity. Join a team where your… more
- Saratoga Hospital (Saratoga Springs, NY)
- …Under general supervision of the Manager, Health Information Services, the Denials Specialist performs activities to ensure appropriate financial reimbursement ... documentation improvement, Patient Access (PA) and Patient Financial Services (PFS). The Denials Specialist is responsible for tracking denied HIS inpatient… more
- Catholic Health (Buffalo, NY)
- …with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals, Clinical Supervisor is responsible for the ... correspondence, and may include setting up arbitration between parties. This individual provides clinical oversight to the clinical denials team, ensuring… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ... ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA) indicators, discharge disposition,… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... with the System Business Office related to appeals, denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and incoming fax… more
- Stanford Health Care (Palo Alto, CA)
- …States of America) **This is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role ... in the Revenue Cycle Denials Management Department by managing and resolving ...as well as excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …managing medical denials by conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling ... Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to front-end ... Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and… more
- Penn Medicine (Philadelphia, PA)
- …each day. Are you living your life's work? Job Title: Accounts Resolution Specialist I Department: Ophth Clinical Support Location: Penn Presbyterian Medical ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more