- 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 optimizing the revenue cycle and supporting accurate… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity… 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, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Cognizant (Phoenix, AZ)
- …advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process ... well as timely filing deadlines and processes. . Review clinical denials including but not limited to...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Catholic Health (Buffalo, NY)
- …8-4 with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for ... include setting up arbitration between parties. This individual provides clinical oversight to the clinical denials... areas and third-party payers in scenarios related to denials and appeals . This position educates all… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld… more
- Hartford HealthCare (Farmington, CT)
- …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... **Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:**… more
- Houston Methodist (Sugar Land, TX)
- …and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical...cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or… more
- HCA Healthcare (Brentwood, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can ... resources you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals.… more
- Houston Methodist (Houston, TX)
- …staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a ... At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating... is responsible for coordinating and monitoring the coding-specific clinical charges and denial management and appeals … more
- Dana-Farber Cancer Institute (Brookline, MA)
- Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to ... denials by conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to...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)
- …we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials ... and rejections. + Assists in preparing reports regarding denials to include volumes, number of appeals ,...TRAINING AND EXPERIENCE: + Minimum of 2-5 years of clinical nursing experience in an acute care hospital setting… more
- McLaren Health Care (Mount Clemens, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... education sessions to maintain competency and knowledge of regulations in denials , utilization management, care management, clinical documentation, and… 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 ... quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop… more
- Stanford Health Care (Palo Alto, CA)
- …in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials . This position ... skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with ...regulations, payor policies, and industry best practices related to clinical appeals and denials management.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials ...Creates cost estimates for waivers. + Root causes claim denials , reprocesses, and submits claim appeals . +… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… 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 ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… 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 ... management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers… more