- Beth Israel Lahey Health (Burlington, MA)
- …provider escalation grids for submissions monthly or sooner as needed 17. Assists in reviewing appeals compiled by PFS Denial Specialist I to ensure accuracy ... **Work Shift:** Day (United States of America) The PFS Denial Specialist II role is vital to...interprets third party denials. 7. Initiates corrected claims and appeals according to payer guidelines. 8. Responds to incoming… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...Vision, and Values in behaviors, practices, and decisions. Coordinates denial management processes (Clinical and Administrative/Technical accounts, focusing upon… more
- Beth Israel Lahey Health (Burlington, MA)
- …Regular **Scheduled Hours:** 40 **Work Shift:** Day (United States of America) The Denial Specialist role is vital to ensure that hospital denied accounts ... interprets third party denials 7. Initiates corrected claims and appeals according to payer guidelines. 8. Initiates denial... appeals according to payer guidelines. 8. Initiates denial write off when appropriate after thorough review. 9.… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Denial Coding Review Specialist ? At Parallon, you come first. HCA Healthcare has ... lives and you have the opportunity to make a difference. We are looking for a dedicated Denial Coding Review Specialist like you to be a part of our team. **Job… more
- Beth Israel Lahey Health (Burlington, MA)
- …interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating ... by management. Analyzes work queues and other system reports and identifies denial /non-payment trends and reports them to the Billing Supervisor. 2. Ability to… more
- Beth Israel Lahey Health (Charlestown, MA)
- …interprets third party payments, adjustments and denials. Initiates corrected claims, appeals and analyzes unresolved third party and self-pay accounts, initiating ... by management. Analyzes work queues and other system reports and identifies denial /non-payment trends and reports them to the Billing Supervisor. 2) Ability to… more
- HCA Healthcare (Brentwood, TN)
- …to join an organization that invests in you as a Clinical Denials Coding Review Specialist ? At Work from Home, you come first. HCA Healthcare has committed up to ... are looking for a dedicated Clinical Denials Coding Review Specialist like you to be a part of our...and process or appeal as appropriate + Compose technical denial arguments for reconsideration, including both written and telephonically… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...complaints. 14. Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for division… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials/ appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for A/R, ... Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing...timely to prevent past filing deadlines. * Communicates all denial write offs to Collection Supervisor, and Collections Manger.… more
- Molina Healthcare (Columbia, SC)
- …be licensed in the state you reside. We are looking for a Clinical Nurse Appeals RN to support our SC Health plan (Medicaid and Marketplace). Strong experience with ... appeals reviews and/or utilization management working on the manage...and other appropriate criteria with Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management… more
- Providence (Irvine, CA)
- **Description** **Claims Appeals Representative \*Remote * Candidates in AK, WA, MT, OR, CA or TX are encouraged to apply.** The Appeal and Grievance Specialist ... and payer logistical perspective. Works closely with the Clinical Denial RN and support staff to review denied accounts,...outcomes of follow-up activities. Works closely with the Clinical Denial RN on nuances associated with denials of a… more
- Houston Methodist (Houston, TX)
- …is responsible for coordinating and monitoring the coding specific clinical charges and denial management and appeals process in a collaborative environment with ... specific current procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons, and appeals . Monitors recovery of payments and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- Universal Health Services (Tredyffrin, PA)
- …established performance targets (productivity and quality). Initiates and follows-up on appeals . Exercises good judgement in escalating identified denial trends ... - Independence Physician Management - UHS. Position Overview The Accounts Receivable Specialist is responsible for the accurate and timely follow-up of unpaid and… more
- Beth Israel Lahey Health (Burlington, MA)
- …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands on coding, documentation review and other coding needs ... by management. Analyzes work queues and other system reports and identifies denial /non-payment trends and reports them to the Billing Supervisor. 2. Responds to… more
- Transdev (Oakland, CA)
- …and making determinations of paratransit eligibility and establishing reasons for denial of ADA eligibility appropriate for presentation during an Appeals ... eligibility, including category, conditions of eligibility and reasons for denial . + Present individual cases of eligibility denial...and professional manner (both verbal and written) to an Appeals Panel for an Appeals Hearing process.… more
- UNC Health Care (Chapel Hill, NC)
- …coverage with local and state Medicaid offices to obtain reversal of initial denial . Abstracts information, prepares appeals and represents UNC Health Care ... entire Medicaid application process from application to award or denial . Positions have authority to represent the Health Care...Care System at each of the four levels of appeals when applications are denied. **Responsibilities** : 1. Obtains… more
- Hologic (San Diego, CA)
- Medical AR Specialist San Diego, CA, United States Biotheranostics provides comprehensive and proprietary diagnostic solution for metastatic cancer. The company ... with a high level of knowledge, skills and experience, Accounts Receivable Specialist performs a variety and full range functions related to Biotheranostics customer… more
- Beth Israel Lahey Health (Charlestown, MA)
- …**Scheduled Hours:** 40 **Work Shift:** Day (United States of America) The Billing Specialist role specializes in high dollar claims, aged claims and denied claims ... cause and accurately appeal claims to ensure successful initial submission. The Billing Specialist will be responsible for charge and claim review to ensure the… more
- Beth Israel Lahey Health (Danvers, MA)
- …**Scheduled Hours:** 40 **Work Shift:** Day (United States of America) The Billing Specialist role specializes in high dollar claims, aged claims and denied claims ... cause and accurately appeal claims to ensure successful initial submission. The Billing Specialist will be responsible for charge and claim review to ensure the… more