- University Medical Center of El Paso (El Paso, TX)
- Job Description: The Denials and Appeals Specialist follows up on denied claims from commercial and contracted payers. Performs timely and appropriate ... review, managed care, and/or claims denials and appeals processing required. License/Registration/Certification: Certified Clinical Documentation Specialist … more
- Blanchard Valley Health System (Findlay, OH)
- …Valley Facility and Professional services as well as the appeal of denials /rejections from third-party payers. The specialist will manage their assigned ... with multiple departments and communicate to the Denial Avoidance Specialist when identifying trends relating to denials ....to effectively reduce days in A/R. Develops and writes appeals for denials associated with the payment… more
- Accounting Now (Tampa, FL)
- Medicare Appeals Specialist Do you like challenging payers? Enjoy that feeling of satisfaction when your appeal is overturned? Then, this position may is right ... Medicare for collection on behalf of hospitals (facility charges).Understanding of medical terminology, bill review, general coding, and appeals … more
- Accounting Now (Tampa, FL)
- … Nurses and Coding Denials Specialists to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely manner. ... The Denials Specialist performs advanced-level work related...resolve issues related to appeals and initial denials .Communicates with Pre-Cert team and/or medical office… more
- Accounting Now (Pinellas Park, FL)
- … Medical Collectors in St Petersburg, Florida: Medical Collector The medical billing and collection specialist is responsible for ensuring accurate ... of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and collection specialist must possess critical thinking… more
- Beth Israel Lahey Health (Charlestown, MA)
- …Type:** Regular **Scheduled Hours:** 40 **Work Shift:** Day (United States of America) **The Denials Specialist role is eligible for a $1,500 sign on bonus.** ... 7-3:30PM) with a comprehensive benefit program.* **Job Description:** The Denials Specialist position is a key role...denials with a focus on reviewing and interpreting denials and facilitating first and second level appeals… more
- Trinity Health (Farmington Hills, MI)
- …activities as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and ... Performs day-to- day payment resolution activities within the Hospital and/or Medical Group revenue operations ($3-5B NPR) for an assigned Patient Business… more
- Trinity Health (Farmington Hills, MI)
- …Maintains knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues ... day-to- day payment resolution activities within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of an assigned...location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials ). Serves as… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials / appeals experience ( Medical A/R) + Hospital/facility collections experience Description: Responsible for ... to increase efficiency of collections. * Responsible for timely medical records requests and submission of appeals ...timely medical records requests and submission of appeals * Maintain adequately trained staff to achieve daily… 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 ... functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** +...various sources ( medical records, claims data, payer medical policies, etc.), determines the causes for denials… more
- St. Luke's University Health Network (Allentown, PA)
- … Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists ... Reviews all Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity... and rejections. + Assists in preparing reports regarding denials to include volumes, number of appeals ,… more
- Insight Global (Nashville, TN)
- Job Description Job Purpose: The Denials Specialist generates revenue by monitoring and pursuing payment on all unpaid and delinquent denied claims; serving as a ... timely claim submission and payment Work average of 30-50 denials per day based on supervisor requirements and accounts...importance and relationship to patient care Initiate and complete appeals for disputed / denied claims. Works / Understands… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** The Supervisor of Denials -PFS is responsible for reviewing all denial material and ensuring accurate second ... level appeals are filed for denied claims. **Required Qualifications** +...regulations of affiliated payors through coordination with Contract Reimbursement Specialist .Centralizing and reviewing all denial material (correspondence, EOBs, zero… more
- SSM Health (Jefferson City, MO)
- …Responsibilities and Requirements:** Job Description PRIMARY RESPONSIBILITIES + Composes DRG/APC appeals based on medical record documentation, coding guidelines ... seeking a highly skilled and detail-oriented Coder for Hospital Denials to join our team at SSM Health. You...at SSM Health. You will be responsible for reviewing medical records and accurately coding diagnoses and procedures for… more
- Universal Health Services (Bonham, TX)
- …TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare ... payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety… 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...reflect the standard of care, as defined by the medical staff and the organization; utilizes clinical knowledge and… more
- Molina Healthcare (Milwaukee, WI)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates... appeals and denials . + Strong verbal and written communication skills To… more
- St. Luke's University Health Network (Allentown, PA)
- …for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding ... related claim denials for professional services, FQHC, MSO, and ASCs across...documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process.… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits...resolution. Engages the coding follow up team for any medical necessity or coding related appeals . +… more
- Hartford HealthCare (Farmington, CT)
- …and homecare to insure optimal revenue cycle performance. The AR Follow Up & Denials Specialist is responsible for resolving unpaid third party balances on $550 ... million in active inventory and $70 million in denials through account follow up, appeals and...management or finance. *Experience* . Minimal: 2 -4 years medical billing and/or accounts receivables experience in a facility… more
