- Diversicare Healthcare Services & Diversicare Ther (Brentwood, TN)
- …our patients and residents. Join Diversicare Healthcare Services today!** **Responsibilities** As the Director of Denials and Appeals you will Develop, ... Implement and Maintain a Denials / Appeals Management program for all payer types. This will...and maintain an electronic tracking system for all adrs, denials , and appeals . 2. Communicate and collaborate… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials / appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for ... underpaid, or non-paid balances. * Refers accounts to Supervisor/Manager, or CBO Director for write-off consideration, agency or attorney referral. * Responsible for… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus ... on Utilization Management and Denials principles such as performance improvement, healthcare finance (including contractual arrangements, utilization/quality… more
- University of Utah (Salt Lake City, UT)
- …billing regulations, and payer processes related to coding policy, medical necessity, denials and appeals . 10. Research and evaluate coding, documentation ... + Revenue cycle expertise with a focus on coding denials and appeals + Experience with CPT...sexual misconduct including sexual harassment, you may contact the Director /Title IX Coordinator in the Office of Equal Opportunity… more
- Actalent (Dayton, OH)
- …to providers and members. * Issue administrative denials appropriately. * Refer denials based on medical necessity to medical director . * Maintain hardcopy ... We are currently hiring for a Clinical Appeals Nurse in a fully REMOTE role! A...or turn into something more long-term. Description: The Clinical Appeals Nurse is responsible for the completion of clinical… more
- Actalent (Dayton, OH)
- …to providers and members. + Issue administrative denials appropriately. + Refer denials based on medical necessity to medical director . + Maintain hardcopy ... but must be located in Ohio. SUMMARY: The Clinical Appeals Nurse is responsible for the completion of clinical... Nurse is responsible for the completion of clinical appeals and state hearings from all states. RESPONSIBILITIES: +… more
- Actalent (Dayton, OH)
- …to providers and members. * Issue administrative denials appropriately. * Refer denials based on medical necessity to medical director . * Maintain hardcopy ... Description: * Responsible for the completion of clinical appeals and state hearings from all states *...all states * Review and complete all provider clinical appeals within required timeframes. * Review and complete member… more
- CVS Health (Columbus, OH)
- …concurrent and prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director will perform appeals in their "base ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...to precertification, concurrent review, and appeal request. The medical director is a work-at-home position located anywhere in the… more
- SSM Health (Jefferson City, MO)
- …through process improvement. + Oversees communication and follow-up processes related to denials and appeals to ensure such activities are submitted timely, ... Coordinates with Health Information Management and Case Management leadership on con-current denials . Review denial data appeals and under payment issues and/or… more
- HCA Healthcare (Plano, TX)
- **Description** **Introduction** The Director of Reimbursement directs and coordinates activities of employees engaged in back-office revenue cycle management ... including data entry, claims filing, appeals /reconsiderations, payment posting and reconciliation, physician query processes, denial analysis, coding analysis, fee… more
- AdventHealth (Maitland, FL)
- …**The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members of the Case ... prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization, claims management,… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals ... **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and… more
- Randstad US (Louisville, KY)
- …'s responsibilities include identifying patient reimbursement issues, ensuring that claims, denials , and appeals are efficiently processed, and resolving ... revenue cycle director . + louisville , kentucky + posted april...Revenue Cycle + Medical Billing + Medical Billing - Denials + Medical Insurance + Medical Coding Qualifications +… more
- UPMC (Moosic, PA)
- We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care! As Senior Medical Director , you ... to learn more and apply today! The Senior Medical Director provides guidance for clinical operational aspects of the...the providers in its network. + Reviews proposed service denials and supervises care managers in the utilization of… more
- UNC Health Care (Chapel Hill, NC)
- …responsible for the daily operations of the Utilization Management and Clinical Denials Management functions of the department as well as collaborating with ... utilize transformative knowledge and skills as we approach complex payor communications and appeals work. This position is fully onsite at the UNC Medical Center… more
- The Cigna Group (Bloomfield, CT)
- …and perform all appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services ... appeals from members, member representatives and providers regarding denials for services and denials of payment...a written detailed clinical summary for the Plan Medical Director . + Determine whether additional pre service, appeal or… more
- HCA Healthcare (Austin, TX)
- …QAPI program including chart audits and oversight of adverse events. Assists with processing appeals and denials as requested. + Provides a lead role regarding ... **Description** **Introduction** We are seeking a Hospice Director of Clinical Services with St. David's Hospice...may vary by location._** We are seeking a Hospice Director of Clinical Services for our team to be… more
- Prime Healthcare (Ontario, CA)
- …Claims and Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using ... Human Resources. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides comprehensive oversight… more
- WMCHealth (Warwick, NY)
- …. + Supervises and coordinates the activities associated with billing, follow-up, and denials and appeals . + Works with staff, payer representatives, vendors, ... Supply Chain Automation is responsible for overseeing the billing, follow-up and denials management function at Bon Secours Charity Health System. This position is… more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… more