- Catholic Health (Buffalo, NY)
- …liaison between front-end clinical areas and third party payers in scenarios related to denials and appeals . This position educates all members of the patient ... position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons...on an ongoing basis in relation to trends in denials , and clinical documentation. Responsible for working alongside coding,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs...Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow… more
- The Cigna Group (Houston, TX)
- …HCPCS Guidelines, AMA CPT Guidelines, and CMS directives, as related to claim denials and appeals + Pursues collection activities to obtain reimbursement from ... experience preferred + 5+ years of supervisor or manager experience preferred + 2+ years minimum of front...email, Salesforce + Working Knowledge of Health Insurance EOB's, denials and appeals + Ability to meet… more
- Guidehouse (Birmingham, AL)
- …to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/ Manager as needed with various projects. + Escalate ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...medical billing and/ or payer experience working with UB04, appeals & denials . + Ability to initiate… more
- AdventHealth (Altamonte Springs, FL)
- …contribute:** This position is responsible for investigating and appealing post-remit denials for all Inpatient and Outpatient clinical services across the system, ... will bring to the team:** + Reviewing and appealing denials for all clinical services across the AH system...obtain further patient information to be used in the appeals process if necessary. + Provide reports, education, and… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization/ appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors and/ or ... accurate utilization data in a timely fashion. | Monitors denials as well as all financial metrics associated with...departments. | Develops/validates daily work lists for Utilization and Appeals Manager . | Assist with all insurance… more
- Penn Medicine (Philadelphia, PA)
- …shortages.Coordinator is responsible for management of lists and processes related to denials and appeals .Coordinator also prepares quarterly denial reports by ... Experience:** + Bachelors degree in Nursing and 5+ years Working as a RN Case Manager and /or Appeals Coordinator required. We believe that the best care for… more
- Methodist Health System (Dallas, TX)
- …Of Week :** Mon-Fri **Work Shift :** **Job Description :** Your Job: The Manager of Collections Physician Billing is responsible for overseeing the AR follow up team ... drive performance improvements and meet departmental and organizational goals. The Manager will work closely with various internal and external departments,… more
- Ophthalmic Consultants of Boston (Plymouth, MA)
- …operations. This role handles a high volume of claims processing, insurance denials , appeals , contract management, prior authorization submissions, and managing ... with a demonstrated ability to apply this knowledge to claim processing and appeals . + Extensive experience managing insurance denials , appeals , and… more
- Johns Hopkins University (Baltimore, MD)
- …issues and facilitate prompt payment of claims. Communicates with providers regarding appeals and medical policy denials and provides appropriate proactive ... related to specialized, complex or high-cost procedures. + Contacts providers regarding appeals and medical policy denials , identifies and collects additional… more
- NTT America, Inc. (Plano, TX)
- …and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a **Medicare ... Appeals Clinical Leader** to lead service delivery engagements and...interpret medical records, documenting recommendations to uphold or overturn denials + Excellent analytical and problem-solving skills + Strong… 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
- Surgery Care Affiliates (Boise, ID)
- …Effectively and independently manages second level reimbursement issues, contracted and non-contracted denials and appeals . + This is a demanding environment, ... by working with insurance providers to resolve issues. + Denials and Claims: + Handle denials and...and ensure proper reimbursement. + Notify the Billing Office Manager of any issues or claims that cannot be… 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
- Catholic Health Initiatives (Houston, TX)
- …processes concurrent denials that require medical necessity determinations; processes appeals and reconsiderations. Act as a working manager within ... **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM operations within the markets, focusing on effective team… more
- Beth Israel Lahey Health (Burlington, MA)
- …availability, and discusses issues with outside auditors and the inpatient coding manager /CDI. Prepares appeals on appropriate cases to ensure proper ... security and integrity of patient information. Manage audits. Oversee appeal of denials . Oversee ROI operations, high volume call center and information request… more
- Cardinal Health (Fresno, CA)
- …denials management by root cause analysis and coaching + Manage all preservice denials and appeals + Monitors, tracks, and analyzes staff productivity + ... in patient access management specifically responsible for authorizations, verification of benefits, denials and/or appeals . + Bachelor's degree in related field,… more
- Baptist Memorial (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 ... the entire appeal process and determines if escalation to manager or payer is next step to get a...BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. + Requires a… more
- Baptist Memorial (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 ... the entire appeal process and determines if escalation to manager or payer is next step to get a...BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. + Requires a… more
- Arnot Health (Elmira, NY)
- …Arnot Health departments and third party payers to discourage preventable denials DUTIES AND RESPONSIBILITIES: 1. Retrospectively determines medical necessity and ... admission and stay in accordance with InterQual Criteria to assist with appeal of denials 2. Maintains a working knowledge of the requirements of 3rd party payers 3.… more
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