- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials / appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for ... underpaid, or non-paid balances. * Refers accounts to Supervisor/Manager, or CBO Director for write-off consideration, agency or attorney referral. * Responsible for… more
- Beth Israel Lahey Health (Charlestown, MA)
- …you're making a difference in people's lives.** Under oversight of the Director , the Manager, BILH Patient Financial Services Hospital Billing is responsible for ... Cash Posting, Denial Management, and overall Revenue Cycle operations. Assists Director with system wide policies, objectives, and initiatives for Hospital revenue… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as ... payor types striving to minimize lost revenue. Conducts analysis on denials and appeals and identifies trends that present process improvement and revenue… more
- Robert Half Accountemps (Cincinnati, OH)
- …and managing billing processes for a healthcare facility, with a focus on claim denials and appeals . The employment type for this role is temporary. ... a unique opportunity in the healthcare industry for a Denials Specialist located in Cincinnati, Ohio. This role involves...payer trends and issues prohibiting proper payments to the Director * Maintain clear and concise notes on each… more
- Centene Corporation (Tallahassee, FL)
- …Florida to be considered for the role. **Position Purpose:** Facilitate medical necessity appeals and denials including disposition of denials notification ... for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases to the Medical Director for review… more
- Fallon Health (Worcester, MA)
- …and non-contracted providers with appeals regarding filing limit appeals , claim denials , claim payment, retrospective referrals, administrative inpatient ... a timely resolution according to internal measures/targets. + Present appeals to the Fallon Health Medical Director (s)...Present appeals to the Fallon Health Medical Director (s) as appropriate. + Serve as the liaison between… more
- CVS Health (Springfield, IL)
- …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
- 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
- Highmark Health (Charleston, WV)
- …satisfaction, and quality outcomes. A key component of this role is to review denials of care based on medical necessity. The incumbent acts as a liaison for ... providers across the network. + Attend meetings as appropriate, including medical director meetings, QI committee and subcommittees, as assigned. + Contribute to the… more
- Nuvance Health (Danbury, CT)
- …for denials identification and remediation of root causes, submit appeals , funnel education back to responsible parties, and track success towards future ... Director Patient Access Pre-Services Location: Danbury, CT, United...denial prevention and effective appeal writing to overturn administrative denials . Provides support for de-centralized financial clearance, or act… more
- Nuvance Health (Norwalk, CT)
- …NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials . Oversees appeals , at the first level of appeal as appropriate, in ... Case Managment /Care Coordination Director Location: Norwalk, CT, United States Requisition ID:...management and high-risk case management. Works collaboratively with the Director of transitions to ensure optimum utilization of Social… 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
- Universal Health Services (Streamwood, IL)
- …of care. Provide trainings to improve clinical documentation and meet goals set on appeals and denials . Run UM committee meetings providing reports to the ... Responsibilities Director of Utilization Management Full-Time The Director of Utilization Management is responsible for the oversight of the utilization… more
- Guidehouse (Lewisville, TX)
- …None **What You Will Do** **:** Working under the general direction of the Director or Vice President of Operations, the **Associate Director , PFS** serves as ... and operations related to billing, insurance and self-pay follow-up, denial appeals , and resolution of credits/refunds. Additionally, the position will monitor goals… more
- Insight Global (Miami, FL)
- Job Description The Director of Revenue Cycle Management is responsible for the successful management of the RCM AR Management Operations Team. The position manages ... follow-up, denial management, patient customer service, and underpayments recovery. The Director is responsible for establishing and monitoring the department goals,… more
- HCA Healthcare (Greenwood Village, CO)
- …QAPI program including chart audits and oversight of adverse events. Assists with processing appeals and denials as requested. + Provides a lead role regarding ... over 156,000 hours impacting our communities. As a Hospice Director of Clinical Services with HealthONE Hospice & Family...by location._** Come join our team as a Hospice Director of Clinical Services. We care for our communities… more
- Houston Methodist (Katy, TX)
- …to include areas such as insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, etc. This position is ... At Houston Methodist, the Director System Revenue Cycle position is responsible for...and developing/implementing action plans to respond to fluctuations. The Director position responsibilities include overseeing the activities of the… more
- The Cigna Group (Nashville, TN)
- …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
- 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