- Trinity Health (Farmington Hills, MI)
- …Work Remote Position (Pay Range: $34.9314-$52.3971) Responsible for reviewing all post-billed denials (inclusive of clinical denials ) for medical necessity ... location responsible for identifying and determining root causes of clinical denials . Responsible for leveraging clinical...and reviews findings with all levels of Payment Resolution Specialist for further review. Serve as a resource to… 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 ... you have the opportunity to make a difference. We are looking for a dedicated Clinical Denials Coding Review Specialist like you to be a part of our team.… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding specific clinical charges and denial ... payers to successfully clear front end claim edits, appeal clinical denials , and address customer service inquiries....Professional Coder (AAPC) **OR** + CCS - Certified Coding Specialist (AHIMA) **OR** + An approved Specialty Society Coding… 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 tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record… more
- Trinity Health (Farmington Hills, MI)
- …Patient Business Services (PBS) location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials ). Serves as part of the ... as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves payment… 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, ... on accounts. Including but, not limited to Managed Care, Reimbursement, Clinical , Admissions, Facility Business Office Manager, Coding, Case Management, HIM and… more
- SSM Health (Jefferson City, MO)
- …**Job Highlights:** We are seeking a highly skilled and detail-oriented Coder for Hospital Denials to join our team at SSM Health. You will be responsible for ... reviewing medical records and accurately coding diagnoses and procedures for hospital denials . This role requires strong analytical skills, attention to detail, and… more
- Sharp HealthCare (San Diego, CA)
- …(correspondence, EOBs, zero payments on acct, etc., notes in IDX from clinical /financial staff).Working with Insurance Specialist to identify additional denial ... and employer business practices. **What You Will Do** The Supervisor of Denials -PFS is responsible for reviewing all denial material and ensuring accurate second… more
- St. Luke's University Health Network (Allentown, PA)
- …clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network. Utilizes ... coding errors and MUE frequency for clean claim submission + Resolve coding denials through claim correction or appeal. Claim corrections will be made after review… more
- Texas Health Resources (Arlington, TX)
- …Professional Coder Upon Hire **REQUIRED** or CCS-P - Certified Coding Specialist - Physician-based Upon Hire **REQUIRED** and Other Specialty certification such ... Hire Preferred **Required Skills** . Advanced knowledge of procedural and clinical diagnosis coding pertaining to professional billing. . Knowledge of third-party… more
- Alameda Health System (San Leandro, CA)
- …made to discontinue the process; assumes the responsibility for coordinating and appealing clinical denials per department policy; develops any appeal letters to ... Care Management Clinical Appeals Specialist + San Leandro,...Management team when cases do not meet criteria; coordinates denials with the attending physician and the Care Management… 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 ... across the Home Health enterprise for all payor types striving to improve clinical documentation and minimize lost revenue. Conducts analysis on timely submission of… more
- Tufts Medicine (Burlington, MA)
- …can't wait to grow alongside you. **Job Profile Summary** The role of the Clinical Documentation Integrity (CDI) Specialist III is responsible for concurrent and ... of the medical record to improve overall quality and completeness of clinical documentation. The CDS III facilitates and obtains appropriate modifications to … more
- Albany Medical Center (Albany, NY)
- …contract and works diligently toward the identification, mitigation, and prevention of clinical denials . In addition to contacting payers and providers via ... America) Salary Range: Min. $23.96/hr - Max $38.34/hr The Clinical Pre-Authorization Specialist will assist the Patient...ensure accuracy by Payer and Product line. + Reviews clinical denials including those related to pre-authorizations;… more
- University of Colorado (Aurora, CO)
- Clinical Utilization Review Specialist - 32339 University Staff **Description** **University of Colorado Anschutz Medical Campus** **School of Medicine | ... Department of Psychiatry** **Job Title: Clinical Utilization Review Specialist ** **Position: #00217340 -...of discussion and appeal letters for Medicaid medical necessity denials . + Review, process and audit the medical necessity… more
- Corewell Health (Southfield, MI)
- …field + 5 years of relevant experience in a clinical role + Certified Clinical Documentation Specialist (CCDS) within 2 years of hire One of the following ... Job Summary Conducts thorough analysis encompassing clinical review and assessment of patient records focusing...address problem areas identified through quality studies or claim denials working directly with physicians and other health care… more
- Fairview Health Services (St. Paul, MN)
- **Overview** The Coding Documentation Integrity Specialist performs concurrent inpatient chart reviews for documentation improvement opportunities. Communicates with ... physicians to ensure comprehensive medical record documentation to reflect clinical treatment and diagnose. Uses provided CDI software to identify opportunities,… more
- MD Anderson Cancer Center (Houston, TX)
- **Summary** Analyzes medical records and abstracts clinical data by assigning codes from patient records in accordance to coding classification systems. Reviews ... data. **Key Functions** 1. Analyzes medical records to abstract clinical data by assigning codes from patient records in...9. Resolves claim and billing edits as well as denials by performing second review of medical record documentation… 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
- Carle (Urbana, IL)
- RN - Clinical Transition Specialist + Department: IP Clinical Case Mgmt - CFH + Entity: Champaign-Urbana Service Area + Job Category: Nursing + Employment ... prior authorizations for swing bed patients, maintain the work ques, and address denials . + RMH: make follow up appointments with primary care provider before… more