- HCA Healthcare (Richmond, VA)
- …technical denial arguments for reconsiderations. Identify contract protection to leveraged overturn denials . Argue appeals that prevent claim payment and gain ... Appeals Specialist Experience the HCA Healthcare difference where...of each individual is recognized. We are seeking an Appeals Specialist for our team to ensure that we… more
- Vidant Health (Greenville, NC)
- …insurance carriers, CPT code(s), and specialty area, review and submission of coding appeals related to denials to include coding, bundling, duplicate, and other ... include researching and reviewing payer coding guidelines, writing and submitting appeals with supporting documentation. Analyzing assigned denials and making… more
- PhyNet Dermatology LLC (Atlanta, GA)
- …a comprehensive understanding of payer guidelines, policies, and requirements related to denials and appeals . Update demographic and account information as ... join our team. If you excel at insurance follow-up, denials management, and claims resolution, we encourage you to...provider notes, and Explanation of Benefits (EOBs) to facilitate appeals or resolve accounts. Initiate and manage appeals… more
- St. Barnabas (Bronx, NY)
- …that may be necessary to complete the job requirements. ** Ensures that claims, denials , and appeals are efficiently processed and reported on a regular schedule ... claims submission, collection and analysis (DRG, APC, Managed Care contracting) Hospital denials and appeals management experience Experience with managed care… more
- Northwestern Memorial Healthcare (Chicago, IL)
- …collection of third party payer receivables and tracking of third party yields. Denials and Appeals management including root cause analysis to reduce/prevent ... future denials while working to overturn denials for payment resolution. Compliant follow-up correspondence to third party payers regarding outstanding accounts… more
- Sharp HealthCare (La Mesa, CA)
- …with providers. Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers. Review all ... organization goals including reductions in length of stay, decreasing denials , improvement of care transitions, and reduction in avoidable readmissions,… more
- Axsome Therapeutics (New York, NY)
- …and processes (ie, eligibility and benefit verification, prior authorization, and appeals / denials ) supporting patient access to Axsome Therapeutics migraine ... product Educate office staff on the prior authorization process, denial and appeal options, and financial support options for migraine product Proactively engage with assigned accounts supporting internal/external customer access needs and compliantly engage… more
- Axsome Therapeutics (Rochester, MI)
- …policies and processes (ie, eligibility and benefit verification, prior-authorization, and appeals / denials ) Maximize use of marketing resources to maintain and ... develop customer relationships for the purpose of growing the customers' confidence to prescribe Axsome medications for appropriate patients Communicate territory activity in an accurate and timely manner as directed by management Provide feedback to sales and… more
- Boston Childrens Hospital (Boston, MA)
- …authorizations for the appropriate level of care for admissions and with post-discharge appeals of payer denials . They identify and implement initiatives to ... manage utilization trends, collaborating with the hospital's discharge planning case managers, healthcare team, and Patient Financial Services. They are part of an interdepartmental team that works to ensure appropriate patient access to services and efficient… more
- UHS (Wayne, PA)
- …criteria to meet or exceed collection targets and minimize write-offs. Researches claim denials by assigned payer/s to determine reasons for denials correcting ... established performance targets (productivity and quality). Initiates and follows-up on appeals . Exercises good judgement in escalating identified denial trends or… more
- Barrington Orthopedic Specialists (Schaumburg, IL)
- …*Prepare and submit documentation for additional information requests, reconsiderations, and appeals *Contact payers regarding denials , payment issues and claims ... questions *Work closely with insurance provider representatives for complex claims issues *Locate and upload explanation of benefits into practice management system as needed *Contact providers for documentation or corrections needed for proper reimbursement… more
- Baptist Memorial Health Care Corporation (Memphis, TN)
- …to send along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be necessary to provide ... payer guidelines and BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. Requires a strong foundation and knowledge of… more
- DocGo (New York, NY)
- …claim status via phone or web and follow up on unpaid claims. Process appeals on aged insurance claims/ denials . Ability to analyze, identify and resolve issues ... when applicable. Review all EOBs for correct payment, deductible, adjustments, and denials . Determining the status of claims with the insurance company, if the… more
- West Tennessee Healthcare (Jackson, TN)
- …resolution; Denials management processes to include denial/claim research, filing appeals , and resolution of denied patient accounts; Payment Posting and Cash ... for each claim to meet medical necessity guidelines. Adjusts all pre-bill denials before submitting a claim according to defined procedures. Retains and applies… more
- UF Health (Jacksonville, FL)
- …by physicians and non-physician providers maintaining timely claims submissions and timely Appeals process as defined by individual payors. Review and facilitate the ... correction of insurance denials , charge posting and payment posting errors. Complete correspondence...to the appropriate carrier based on each payors specific appeals process with the knowledge of timelines. Research, respond… more
- Adventist Health (Roseville, CA)
- …to include but not limited to medical necessity, compliance risk, review of denials , charge trends, and applied CPT, HCPCS, ICD 10-CM and ICD-10-PCS coding ... improvement recommendations. Ensures timely dissemination of external audits; generates timely appeals and adheres to all deadlines. Generates RAC reports including… more
- Advocare LLC (Marlton, NJ)
- …and following up on overdue accounts. Investigating denied claims, preparing appeals , and submitting necessary documentation to insurance companies. Keeping detailed ... parties. Identifying and resolving billing discrepancies, payment issues, and claim denials . Accurate record-keeping and attention to detail are essential for… more
- MNGI (Minneapolis, MN)
- …including denials and payment inconsistencies. Submit replacement claims and appeals to the insurance companies; submit timely follow up requests for status. ... Assists as needed in processing insurance payments so that all accounts are up-to-date and accurate. Complete insurance Payer Audits quarterly to ensure payments are accurate per our contracted rates. Run service item reports to verify correct… more
- Trinity Health (Silver Spring, MD)
- …conduct verbal and written Peer to Peer reviews to assist with appeals of denied or downgraded coverage determinations by managed care, commercial payers, ... admission criteria for all levels of care) *Understanding of approaches to denials management *Knowledge of clinical, quality, and administrative facets of the… 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
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