- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Clinical Denials Management and Audit monitors, responds to, and performs the clinical denial and ... and plans, training, and provides subject matter expertise around clinical documentation and denials management ....+ Receives, monitors, and responds to Government payer Recovery Audit Program (RAC, ZPIC, etc) requests + Audits patients… more
- Providence (Seattle, WA)
- …Medical staff leadership. Divisional liaison for all matters related to denials management . Provides key stakeholders (directors/managers, staff, physicians, ... **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is...and oversight for divisional pre-service and post-service utilization review, clinical claims audit , clinical appeals… 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
- 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
- HCA Healthcare (San Antonio, TX)
- …environment where diversity and inclusion thrive? Submit your application for our SWAT Clinical Analyst opening with Parallon today and find out what it truly means ... may vary by location._** We are seeking a SWAT Clinical Analyst for our team to ensure that we...Contact facilities, physicians' offices and/or insurance companies to resolve denials /appeals. Analyze and resolve specific billing edits that require… more
- University of Colorado (Aurora, CO)
- …assisting with preparation of discussion and appeal letters for Medicaid medical necessity denials . + Review, process and audit the medical necessity for each ... Clinical Utilization Review Specialist - 32339 University Staff...Experience using Electronic Health Record and Patient Health Information management systems. **Knowledge, Skills, and Abilities:** + Well-developed knowledge… 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
- HCA Healthcare (Brentwood, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Denials Coding Review Specialist? At Work from Home, you come first. HCA ... make a difference. We are looking for a dedicated Clinical Denials Coding Review Specialist like you...with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal… more
- Universal Health Services (Richmond, VA)
- …the Revenue Cycle from beginning to end is preferred. + Experience working in case management or audit with technical denials is preferred. + Strong ... supporting the team with process questions while they analyze clinical claim denials , draft detailed appeal letters,...clinical knowledge for CBO staff and consultation to management as needed. + Other duties as assigned. Benefit… more
- The Cigna Group (Bloomfield, CT)
- …duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B and Part D drug. The ... and responding appropriately to appeals from members, member representatives and providers regarding denials for services and denials of payment via oral and… 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
- University of Michigan (Ann Arbor, MI)
- …independently. + Knowledge of healthcare regulations and compliance requirements + Experience in denials management and appeals is a plus **Work Schedule** This ... Coding and Appeals Coordinator plays a vital role in the revenue cycle management of Rev Cycle Mid-Service by maintaining the financial integrity of the healthcare… 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
- 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
- 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
- Ophthalmic Consultants of Boston (Plymouth, MA)
- …and recommending remedies. + Collect, analyze, interpret, and document information to support audit findings, present to all levels of management and providers ... to other offices as necessary. The ideal candidate will have prior clinical experience, successfully worked across all levels of an Ophthalmic, sub-specialty or… more
- HCA Healthcare (Brentwood, TN)
- …and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. What you will do in this ... to be a part of our team. **Job Summary and Qualifications** As a Denials Coding Review Specialist, you will be responsible for applying correct coding guidelines… 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