- Trinity Health (Farmington Hills, MI)
- …Position (Pay Range: $39.8218-$59.7327) Applies clinical and comprehensive payer and appeals knowledge in reviewing all post-billed denials (inclusive of clinical ... clinical expertise and clinical judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) at Enterprise Patient Financial Services (EPFS) as… more
- Trinity Health (Farmington Hills, MI)
- …clinical expertise and clinical judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) center. Serves ... Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after ... trends and works collaboratively with physician advisor team (PAT), providers, utilization management, coders, insurance companies and revenue cycle leadership… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare team in the management and resolution of activities that assure ... determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e.… more
- Hackensack Meridian Health (Hackensack, NJ)
- …transform healthcare and serve as a leader of positive change. The **Appeal Nurse Specialist ** will be responsible for the timely review and submission of appeals ... level of care change determinations. Gathers and evaluates the information for appeals of Managed Care audits, clinical and technical denials by utilizing various… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit support ... to ensure timely processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all payor types striving to… more
- Enterprise Mobility (St. Louis, MO)
- …with state and federal regulations + Perform detailed research and analysis of administrative appeals + Look for benefit and utilization trends and research new ... is excited to announce an opportunity for a Benefits Specialist to join the team!** The Benefits Specialist...million vehicles and accounted for nearly $35 billion in revenue through a network of more than 10,000 fully-staffed… more
- Baystate Health (Greenfield, MA)
- …to: **Cole Courtemanche, Healthcare Recruiter** **###@baystatehealth.org** **Summary:** The Utilization Management Specialist (UMS)/Hospital Case Manager (HCM) ... Smoothly adjusts to temporary increases in workload. Assists in maintaining Utilization Review/ Appeals and Denials documents to reflect current workflow.… more
- Baystate Health (Springfield, MA)
- …and clear communication between providers, staff, insurers, and families. The specialist works closely with the clinical department staff, prescribing office staff, ... prior authorizations and referrals. Coordinates and processes documentation necessary for insurance appeals related to referrral and authorization as well as other … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …for timely response * Follows up on any prior authorization denials; assists Utilization Management with appeals , as needed * Connects patients with financial ... primarily work remotely (SHIFT: Days). *Purpose of this position:*The Prior Authorization Specialist plays a key role in the patient financial experience by… more
- St. Luke's University Health Network (Allentown, PA)
- …will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include ... collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator. Demonstrate the ability to formulate an appeal rationale… more