- Texas Health Resources (Arlington, TX)
- Clinical Reviews , Denial and Appeals RN Bring your passion to THR so we are Better + Together Work location: Remote (Local candidates only) Work hours: ... and effective appeal strategies for medical necessity denials. + Reviews clinical documentation in order to determine...Develops and maintains relationships with other departments related to appeals and denial management. + Serves as… more
- McLaren Health Care (Grand Blanc, MI)
- …communication with related disciplines to address and integrate opportunities for denial appeals . **Essential Functions and Responsibilities as Assigned:** 1. ... of the patient care team. Educates health team colleagues about complex clinical appeals /denials, utilization review, including role, responsibilities tools, and… more
- BronxCare Health System (Bronx, NY)
- …letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... to appeals status, and outcomes by department denial coordinators, physician advisors, and the clinical ...utilize in the formulation of a strong appeal letter. - Reviews all denial notifications in letter and… more
- Nuvance Health (Danbury, CT)
- …inquiries and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and ... Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals ...cases in work queue and incoming fax queue. 10. Reviews denial letters through daily mail and… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals ... Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical /medical reviews of previously denied cases in which a formal … more
- McLaren Health Care (Mount Pleasant, MI)
- …auditors . Provides support to both internal and external customers for denial / appeals activities and audits. Assists with monitoring and auditing activities, ... outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer… more
- Nuvance Health (Danbury, CT)
- …with appropriate Provider if initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within two hours ... Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient...escalate to the appropriate Provider/VPMA. * Identify and complete clinical reviews required for submission to specific… more
- Mount Sinai Health System (New York, NY)
- …(CCM, ACM) or Utilization Management preferred. + 7+ years of experience in clinical acute clinical , utilization management, appeals management or related ... + Ensure timely and appropriate communication with payers for authorization, denials, and appeals . + Collaborate with physicians and clinical teams to ensure… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the ... and training for the financial services staff with regard to clinical and medical necessity insurance denials. Analyzes all correspondence regarding insurance… more
- CVS Health (Boise, ID)
- …contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial . + Can review a clinical determination and understand ... may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach...misrouted work. + Assemble all data used in making denial determinations and can act as subject matter expert… more
- WMCHealth (Valhalla, NY)
- …or continued stay, when necessary. + Secures physician input for insurance appeals when necessary. + Incorporates knowledge of clinical expertise, quality, ... Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services...Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: Clinical Care Mgmt- WMC Health Union: No Position: Full… more
- CaroMont Health (Gastonia, NC)
- …and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews / appeals as part of denial process. The UR Specialist ... departments, Care Management and Senior management as necessary. Retrospectively reviews medical record for clinical denials. Composes...denials. Composes a detailed summary of care and sends appeals to MCO, Medicare, or RAC for reversal of… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. Summary: Coordinates and leads all clinical denial processes and clinical audit activities. Collaborates with ... teammates involved in the denial process. Reviews all denial ...for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... lengths of stay, enhanced organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination… more
- US Tech Solutions (May, OK)
- …prior authorization as per policy and procedure. + The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. + ... questions and collecting appropriate clinical /medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria… more
- Nuvance Health (Danbury, CT)
- …LOC and clinical documentation. * Conducts verbal and written Peer to Peer reviews to assist with appeals of denied or downgraded coverage determinations by ... expertise related to appropriate utilization/level of care (LOC) and appropriate clinical documentation. Provides oversight for other Physician Advisors for both the… more
- University of Southern California (Alhambra, CA)
- …auditors, and determining the need for appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in compliance with ... Coding Denials Management Specialists. * Performs all 1st and 2nd level coding-related denial appeals . * Inpatient coding of all diagnostic and procedural… more
- Fairview Health Services (St. Paul, MN)
- …receipt of expected reimbursement for services provided by the hospital/physician. Reviews and analyzes medical records and coding guidelines to formulate coding ... arguments for appeals and/or coding guidance for potential re-bills. Maintains a...Additionally, this position will actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report… more
- Garnet Health (Middletown, NY)
- …rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities ... Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- Houston Methodist (Houston, TX)
- …required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This ... in account follow-up. Also is responsible for providing information regarding complex denial trends for future prevention. The individual who holds this position… more