- Stryker (Nashville, TN)
- **What You'll Do:** As our **Reimbursement and Market Access Specialist ,** you'll play a key role in ensuring patient access to our innovative IVS products by ... processes-ensuring successful navigation of the billing, prior authorization, and appeals process. **Key Responsibilities:** + Respond to day-to-day reimbursement… more
- HCA Healthcare (Nashville, TN)
- …local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all ... that invests in you as an Impatient Coding Denial Specialist ? At Parallon, you come first. HCA Healthcare has...We are looking for a dedicated Impatient Coding Denial Specialist like you to be a part of our… more
- HCA Healthcare (Nashville, TN)
- …for benefits may vary by location._** We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide all patients with ... apply! **Job Summary and Qualifications** Seeking a Clinical Denials Coding Review Specialist , who is responsible for applying correct coding guidelines and payor… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- CVS Health (Nashville, TN)
- …Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- CVS Health (Nashville, TN)
- …and problems. + Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Applies medical necessity guidelines, ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . + Insures all compliance requirements are satisfied and all… more
- Intermountain Health (Nashville, TN)
- **Job Description:** The Pre-Access Authorization Specialist I is responsible for accurately verifying and completing insurance eligibility, securing prior ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- Elevance Health (Nashville, TN)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from patients, providers and other team ... members related to medications. + Maintains record keeping of prior authorizations, rebates, and monthly reports. + Receive calls from members to address any medication or pharmacy related needs. **Minimum Requirements:** + Requires an active, professional… more
- CVS Health (Franklin, TN)
- …including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing. + Ability to work in a fast paced environment, handling ... both inbound and outbound calls. + Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. + Good communication skills are essential, both internal and external. + Knowledge of Medicare… more
- Elevance Health (Nashville, TN)
- …TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). ... as a Registered Health Information Technician, CCS as a Certified Coding Specialist , CIC as a Certified Inpatient Coder, or Certified Clinical Documentation … more
- Cardinal Health (Nashville, TN)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more