- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely ... remote. The Clinical Denials Prevention & Appeals Specialist plays a critical role in...validation issues by leveraging comprehensive knowledge of clinical documentation, medical coding (with special emphasis on ICD-10), payer policies,… more
- Cognizant (Phoenix, AZ)
- …to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued ... denials including but not limited to referral, preauthorization, medical necessity, non-covered services, investigational/experimental and billing resulting in … more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ... with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role… more
- Catholic Health (Buffalo, NY)
- …hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying ... a 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… more
- Nuvance Health (Danbury, CT)
- …*Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders ... Assists in timely sorting and dissemination of requests for medical information from insurers and other sources to the...appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and… more
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials ,… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... to make appropriate decisions and is accountable for reviewing denials for level of care, medical necessity,...and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** +...various sources ( medical records, claims data, payer medical policies, etc.), determines the causes for denials… more
- Fairview Health Services (St. Paul, MN)
- **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the ... pertaining to billing, coding, and documentation. The Inpatient Coding Denials Specialist will also handle audit-related and...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… more
- St. Luke's University Health Network (Allentown, PA)
- … Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists ... Reviews all Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity... and rejections. + Assists in preparing reports regarding denials to include volumes, number of appeals ,… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Medical Billing & Denials Specialist Department: Patient Financial ServicesLocation: Massena HospitalHours Per Week: 40Schedule: Monday - Friday ... 8AM-4PM SUMMARY: A Medical Billing and Denials Specialist ...fee schedules, DRGs, and reimbursement procedures. + Claims and Appeals Processing: Submits and follows up on insurance claims;… more
- HCA Healthcare (Brentwood, TN)
- …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a part ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock your… more
- Datavant (Hartford, CT)
- …educational and life experiences to realize our bold vision for healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim denials ... practices, and proficiency in multiple electronic systems and software tools. The specialist serves as a key liaison between coding, billing, utilization review,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial ... management. The individual is responsible for managing medical denials by conducting a comprehensive review...a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based… more
- McLaren Health Care (Mount Clemens, MI)
- …responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and ... appeals demonstrating accuracy/proficiency in referencing support from the medical recorddocumentation and coding guidelineswith timely and successful submissions.… more
- Molina Healthcare (IA)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates... appeals and denials . + Strong verbal and written communication skills To… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for ... of data and information. This position provides feedback to facilities regarding denials that are resulting in retractions. **Essential Functions** + Responsible for… more
- Community Health Systems (Franklin, TN)
- …the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education ... references for CHS hospitals via scanned, electronic and hybrid medical records. Based on review findings, writes appeal letters...of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers… more
- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... Denials Management Department by managing and resolving clinical appeals related to government audits and denials ....of Conduct. + Denial Analysis: Conduct thorough analyses of denials , evaluating the appropriateness of medical services… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits...resolution. Engages the coding follow up team for any medical necessity or coding related appeals . +… more
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