- UNC Health (Chapel Hill, NC)
- …communities we serve.RN Utilization Manager position specifically for a Utilization Manager /Clinical Appeals Nurse. This person is based at the Hedrick ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job in Chapel Hill, North...third party payors and resource center. Provides information regarding denials and approvals to designated entities. Assists in coordination… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …guidelines, and quality issues related to utilization management with application for appeals and denials management. * Knowledge of team/small group principles ... Job Summary:The manager role is responsible for all aspects of...employee health disease, exposure, pre-employment, and annual requirements. The manager is responsible for record keeping for all of… more
- AdventHealth (Altamonte Springs, FL)
- …and all measures to resolve assigned accounts, including escalation to supervisor/ manager if necessary. Processes administrative and medical appeals , refunds, ... responsibility of the Account Representative II to bill, follow-up, and manage denials to timely collect on assigned accounts receivable . Daily communicates with… more
- St. Luke's University Health Network (Allentown, PA)
- …clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network. Utilizes ... coding errors and MUE frequency for clean claim submission + Resolve coding denials through claim correction or appeal. Claim corrections will be made after review… more
- Fallon Health (Worcester, MA)
- …and non-contracted providers with appeals regarding filing limit appeals , claim denials , claim payment, retrospective referrals, administrative inpatient ... **Brief Summary of purpose** : Responsible for the coordination and timely completion of provider appeals . Serves as a liaison between Fallon Health and contracted… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... position reports to the Clinical Program Manager . This job description is not designed to cover...or without notice. Primary Responsibilities + Review and analyze denials of initial preservice medical necessity denials … more
- University of Virginia (Charlottesville, VA)
- …analyzes accounts receivable and takes appropriate action to resolve coding and global denials . + Posts denials /rejects into EPIC billing system. + Works complex ... + Other duties as identified by Unit Coordinator, Supervisor and/or Manager . Position Compensation Range: $18.37 - $28.47 Hourly **MINIMUM REQUIREMENTS** Education:… more
- WMCHealth (Warwick, NY)
- …. + Supervises and coordinates the activities associated with billing, follow-up, and denials and appeals . + Works with staff, payer representatives, vendors, ... Manager , System Patient Accounting Company: Good Samaritan Hospital...denials resolution strategies. + Works with the Follow-up Manager to establish and monitor accounts receivable management and… more
- Beth Israel Lahey Health (Burlington, MA)
- …operations as they relate to Epic build decisions, in-depth analysis of denials , complex appeals , audits, credits, cash, coding, workflows, data collection, ... of America) Under the managerial oversight of the Senior Manager , the Revenue Performance Analyst serves as a primary...their respective teams with a goal to accurately process appeals and reduce denials . 20. Representation at… more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… more
- Hartford HealthCare (Southington, CT)
- …staff to improve clinical documentation **Ensures standard work minimizes risk for denials **Participates in quality assurance audits, audits, appeals and ... clients and their clients' families. Basic Purpose of the Position: **Manages appeals at the branch level including clinical documentation review, training, and… more
- Beth Israel Lahey Health (Burlington, MA)
- …needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and ... Billing Supervisor with the resolution of complex claims issues, denials and appeals . 16. Completes projects and...access, web access, or any other means provided by manager . **Organizational Requirements:** 1. Maintain strict adherence to the… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. ... complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims...practice and user trends and makes recommendations to the Manager of Revenue System Operations and partners with the… 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
- CareOregon (Portland, OR)
- …+ Identify and report subcontract performance issues to the Quality Assurance & Compliance Manager for review. Appeals and Grievances + Document and track all ... and NEMT subcontractors to gather supporting documentation to assist in managing grievances, denials or appeals to provide updates as needed. + Ensure all… more
- Crouse Hospital (Syracuse, NY)
- …department. Areas of authority include Utilization Management, Discharge Planning and Denials and Appeals functions. General operational oversight including ... Required: A minimum of five (5) years previous case management, utilization review, appeals and denials and discharge planning experience preferably in an acute… more
- UNC Health Care (Goldsboro, NC)
- …legal, and compliance guidelines Processes all assigned government and nongovernment accounts and denials for complex financial appeals , with a goal of bringing ... with regulatory, legal, and compliance guidelines. Follows rules for overturning appeals and rejections for these accounts. Completes additional research and… more
- UNC Health Care (Goldsboro, NC)
- …legal, and compliance guidelines. Processes all assigned government and nongovernment accounts and denials for complex financial appeals , with a goal of bringing ... with regulatory, legal, and compliance guidelines. Follows rules for overturning appeals and rejections for these accounts. Completes additional research and… more
- Beth Israel Lahey Health (Burlington, MA)
- …education for reimbursement enhancement. 6. Identifies, reviews, and interprets third party denials . 7. Initiates corrected claims and appeals according to payer ... also includes review and rework of all types of denials , as well as analysis and education to reduce...related to orders and/or documentation and makes recommendations to Manager and/or the perspective departments with high volume/high dollar… more
