- Appcast (Randallstown, MD)
- …RN conducts initial, concurrent and retrospective chart review for clinical , financial and resource utilization information. Provides intervention and coordination ... payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying… 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)
- …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
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Manager, Denials Prevention & Appeals Operations is responsible for the direct oversight of daily operations of clinical denial ... are approved for medical necessity. This position will work closely with the Denials Prevention & Appeals Administration Manager to guide the development and… more
- McLaren Health Care (Grand Blanc, MI)
- …for third party payer denials , primarily RAC-related activities and commercial appeals beyond the first level, requiring complex clinical review and appeal ... and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital ... role, you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and… 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 be a ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …managing medical denials by conducting a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling ... Under the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical … 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 , ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… 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 information...cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or… 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 ... personnel, and payers to successfully clear front end claim edits, appeal clinical denials , and address customer service inquiries. Additionally, this position… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …years of experience in clinical care, utilization review, case management, or clinical denials / appeals -OR- * An approved equivalent combination of ... Management Analyst plays a critical role in reviewing, appealing, and preventing clinical denials related to medical necessity, level-of-care, and authorization… more
- St. Luke's University Health Network (Allentown, PA)
- …revenue due to denials and rejections. + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on ... a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party...revenue and trending. + Coordinates RAC appeals for complex case reviews for medical necessity, including… 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 denial ... and submitting appropriate appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation of denials ; +… more
- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of... clinical information. + Provides oversight of the … more
- CommonSpirit Health (Englewood, CO)
- …and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, crafting compelling appeal ... is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews referred by case management staff and/or other health care… more
- CommonSpirit Health (Englewood, CO)
- …We are seeking a highly skilled individual to develop and submit clinical appeals , expertly crafting physician-aligned letters based on federal and ... regulations, including CMS rules and the Two-Midnight Rule, while leveraging clinical criteria and prioritizing medical necessity to defend inpatient status. This… 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
- R1 RCM (Boise, ID)
- …you will help the denials and AR department to finalize and submit appeals to the payor, so that they can service the client and process incoming correspondence. ... Every day, you will communicate with the clinical department and work within different portals to submit appeals . To thrive in this role, you must have a… more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non- Clinical Appeals . + Assisting Supervisor/Manager as needed with various projects. + ... Diploma or equivalent. + 0-2 years medical billing experience working with UB04, appeals & denials . **What Would Be Nice to Have** **:** + Ability to interpret… more
