- Southeast Georgia Health System (Brunswick, GA)
- …You will function as an administrative assistant as needed by the department Manager and/or Director . For our team members, this is more than a career - it's a ... responsible for: Coordinates concurrent and retro precertification processes. Assesses payer denials for appropriateness of appeal and initiates the appeal process… more
- RestoraCare Staffing (Houston, TX)
- …case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement ... in both areas. Refers cases and issues to Care Management Medical Director in compliance with department procedures and follows up as indicated.Communicates with… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus ... on Utilization Management and Denials principles such as performance improvement, healthcare finance (including contractual arrangements, utilization/quality… more
- Universal Health Services (Richmond, VA)
- …training of new hires and provides in-services as appropriate + Works with Appeals Manager to resolve issues associated with denials between other internal ... of the facilities served + Works in conjunction with Appeals Manager to review open and closed denials...reports as assigned. + Assist department manager and assistant director with developing individual and group departmental goals and… more
- Actalent (Dayton, OH)
- …to providers and members. * Issue administrative denials appropriately. * Refer denials based on medical necessity to medical director . * Maintain hardcopy ... We are hiring for a Clinical Appeals Nurse (RN). This is a fully remote...is licensed in Ohio! Description: Job Summary: The Clinical Appeals Nurse is responsible for the completion of clinical… more
- CVS Health (Columbus, OH)
- …concurrent and prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director will perform appeals in their "base ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...to precertification, concurrent review, and appeal request. The medical director is a work-at-home position located anywhere in the… more
- CVS Health (Springfield, IL)
- …concurrent and prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director will perform appeals as needed. * ... to its membership. Aetna is looking for a Medical Director to be part of a centralized team that...to precertification, concurrent review, and appeal request. The Medical Director is a work-at-home position located anywhere in the… more
- HCA Healthcare (Plano, TX)
- **Description** **Introduction** The Director of Reimbursement directs and coordinates activities of employees engaged in back-office revenue cycle management ... including data entry, claims filing, appeals /reconsiderations, payment posting and reconciliation, physician query processes, denial analysis, coding analysis, fee… more
- AdventHealth (Maitland, FL)
- …**The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members of the Case ... prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization, claims management,… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals ... **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and… more
- Caris Life Sciences (Irving, TX)
- …Summary** We are seeking an experienced and effective Credit & Payment Director to oversee assigned processes within the billing operations group. Key areas ... process improvements. **Job Responsibilities** + Lead and manage billing and appeals specialists and support staff, providing guidance, training, and performance… more
- UNC Health Care (Chapel Hill, NC)
- …responsible for the daily operations of the Utilization Management and Clinical Denials Management functions of the department as well as collaborating with ... utilize transformative knowledge and skills as we approach complex payor communications and appeals work. This position is fully onsite at the UNC Medical Center… more
- UPMC (Moosic, PA)
- We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care! As Senior Medical Director , you ... to learn more and apply today! The Senior Medical Director provides guidance for clinical operational aspects of the...the providers in its network. + Reviews proposed service denials and supervises care managers in the utilization of… more
- The Cigna Group (Bloomfield, CT)
- …and perform all appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services ... appeals from members, member representatives and providers regarding denials for services and denials of payment...a written detailed clinical summary for the Plan Medical Director . + Determine whether additional pre service, appeal or… more
- HCA Healthcare (Austin, TX)
- …QAPI program including chart audits and oversight of adverse events. Assists with processing appeals and denials as requested. + Provides a lead role regarding ... **Description** **Introduction** We are seeking a Hospice Director of Clinical Services with St. David's Hospice...may vary by location._** We are seeking a Hospice Director of Clinical Services for our team to be… more
- Prime Healthcare (Ontario, CA)
- …Claims and Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using ... for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides… more
- WMCHealth (Warwick, NY)
- …. + Supervises and coordinates the activities associated with billing, follow-up, and denials and appeals . + Works with staff, payer representatives, vendors, ... Supply Chain Automation is responsible for overseeing the billing, follow-up and denials management function at Bon Secours Charity Health System. This position is… 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, ... serves as a primary point of contact for Billing Director , Service Line Directors, Managers, Finance Directors, clinical support...their respective teams with a goal to accurately process appeals and reduce denials . 20. Representation at… 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
- Billings Clinic (Billings, MT)
- …Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates resolve payer issues. Ensures/Maintains effective ... to Case Manager on current outliers, potential outliers, and denials *Identifies reviews that need to be completed on...and coordinate peer to peer review with payer's medical director *Initiates and coordinates peer to peer reviews on… more
