- Northeast Georgia Health System, Inc (Oakwood, GA)
- … findings methodology to report audit results. CEQAs communicate audit results to physicians, physician leadership, senior management , Compliance department ... with other documentation, coding and billing standards. CEQAs apply standardized audit scoring methodology to evaluate consistency of documentation and coding, and… more
- Accounting Now (Pinellas Park, FL)
- …and/or paper claims, monitoring claim status, researching rejections and denials , documenting related account activities, posting adjustments and collections of ... process appeals online or via paper submission; Assist with billing audit related informationAttend provider meetings/ workshops when neededCommunicate with billing… 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 Support staff managing all areas of clinical claim pre and post audit , appeals...ensure the denial department provides subject matter expertise around clinical denial management . This position will also… 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 ... industry clinical guidelines, evidence-based medicine, local and national medical management standards, and protocols + Performs ad hoc audits and reporting per… more
- Trinity Health (Syracuse, NY)
- …and Defend against federal and payer audits, malpractice litigation, and health plan denials Compare evaluation and management code utilization by provider, with ... communities. Vision: .To be world-renowned for passionate patient care and outstanding clinical outcomes. Core Values: .In the spirit of good _Stewardship,_ we heal… more
- Guthrie (Binghamton, NY)
- …and reports reflecting recovery activity relative to requests, responses, appeals, denials and recoupments. The Coordinator will establish and maintain responsive ... and collaborative relationships with corporate compliance, billing, coding, case management , finance, administration and medical staff. The Coordinator will be… more
- Sevita (San Antonio, TX)
- …requirements across all Company business units and service lines. Ensures that existing clinical audit standards and procedures are best practice according to ... business and operations and to act as a resource for the Operating Group's management team on audit observations. + Reviews compliance with existing policies and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …program. Provides support and expertise for creating compliant queries. Supports denials management process and other initiatives. . KEY RESPONSIBILITIES ... preeminent programs in patient care, education, and research. **Organization:** CDACE - Audit **Job Summary:** JOB SUMMARY Provides leadership in sharing current and… more
- MD Anderson Cancer Center (Houston, TX)
- ** Clinical Billing Specialist** **MISSION STATEMENT** The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the ... professionals, employees and the public. **SUMMARY** The primary purpose of the Clinical Billing Specialist (CBS) position is to provide oversight of professional… more
- Beth Israel Lahey Health (Burlington, MA)
- …or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective ... and all contracting related problems. 21. Responsible for appealing and defending claims denials , adverse audit results, and sanctions. 22. Analyzes work queues… more
- LifePoint Health (Rutherfordton, NC)
- …the patient and family. Must understand payer issues with regard to patient management and resulting implications of clinical decisions and anticipate to ... with any denials through the appeals process; including RAC chart audit reviews. Emergency Department (ED) Case Management1. Serves as a gatekeeper of patients… more
- Hackensack Meridian Health (Hackensack, NJ)
- …determinations. Gathers and evaluates the information for appeals of Managed Care audits, clinical and technical denials by utilizing various Epic and legacy ... at **Hackensack Meridian** **_Health_** includes: + Reviews all retroactive denials in the Epic work queues to assess and...Management . + Collaborates with third party payers and clinical service lines as needed and provides clinical… more
- Scottish Rite for Children (Dallas, TX)
- …will perform audits and reviews of departmental charge capture and reconciliation, denials management for all campuses, daily reporting and coordinated work ... manner + Ensure revenue integrity functions, including charge capture, denials management , unbilled claims, and maintenance of...or more years of experience in a hospital or clinical setting with revenue integrity audit and… more
- Universal Health Services (Dearborn, MI)
- Responsibilities Utilization Management Case Manager Beaumont Behavioral Health (a UHS Facility) A growing 144-bed behavioral health facility - Beaumont Behavioral ... information, please visit our website: https://beaumontbh.com/ PositionSummary The Utilization Management Case Manager is primarily responsible for organizing and… more
- Henry Ford Health System (Wyandotte, MI)
- …outcome management system. + Completes yearly CMS-mandated fiscal intermediary audit including collection and transmittal of required information in an accurate ... CMS on every rehab patient. + Receives all CMS denials for inpatient rehab; tracks all denials ...Collaborates with attending physiatrist, as needed, to construct the clinical rationale. Ensures all timeframes are met at each… more
- Beth Israel Lahey Health (Burlington, MA)
- …expected by Revenue Cycle Leadership. 4. Responsible for appealing and defending claims denials , adverse audit results, and sanctions. 5. Analysis, track and ... or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective… more
- State of Colorado (Denver, CO)
- …Provides medical judgment and final decision authority regarding all medical and clinical issues proposed by the Colorado Recovery Audit Contractor Program ... and Department Staff overseeing this program. Reviews and approves clinical aspects of audit scenarios proposed by...as the Department liaison with providers and the Recovery Audit Contractor to facilitate approvals and prevent denials… more
- Houston Methodist (Katy, TX)
- …**FINANCE ESSENTIAL FUNCTIONS** + Assists management as needed to implement audit findings to reduce compliance errors, avoidable denials , recoupments, and ... staff as needed, updating policies and procedures relative to audit findings and recommendations as indicated by management...that operate at the system level to help enable clinical departments to provide high quality patient care. Houston… more
- Baptist Memorial (Memphis, TN)
- …Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities and current volumes of adjustments. + ... whether Baptist has exhausted all attempts to appeal and overturn timely filing denials . + Communicate audit results to hospital service departments and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Review and analyze denials of initial preservice medical necessity denials using nationally recognized clinical criteria and internal policies/procedures. + ... About The Role BHPS provides Utilization Management services to its clients. The Utilization Review...of Benefit Cases and notifies appropriate parties/departments. + Support clinical quality audit oversight ensuring strict adherence… more
