- RestoraCare Staffing (Houston, TX)
- …case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement ... in both areas. Refers cases and issues to Care Management Medical Director in compliance with department procedures and follows up as indicated.Communicates with… more
- Trinity Health (Farmington Hills, MI)
- …decisions. Manages and oversees day-to-day activities and responsibilities of the payment resolution/ denials team handling the receipt, analysis, and appeals of ... makes recommendations for resolution of issues and findings from Denials Supervisor(s); report findings to the Director ...from Denials Supervisor(s); report findings to the Director Payment Resolution and other PBS leadership. Provides … 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
- Universal Health Services (Richmond, VA)
- …training of new hires and provides in-services as appropriate + Works with Appeals Manager to resolve issues associated with denials between other internal ... of the facilities served + Works in conjunction with Appeals Manager to review open and closed denials...reports as assigned. + Assist department manager and assistant director with developing individual and group departmental goals and… 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
- CVS Health (Springfield, IL)
- …concurrent and prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director will perform appeals as needed. * ... 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
- 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
- Caris Life Sciences (Irving, TX)
- …Summary** We are seeking an experienced and effective Credit & Payment Director to oversee assigned processes within the billing operations group. Key areas ... process improvements. **Job Responsibilities** + Lead and manage billing and appeals specialists and support staff, providing guidance, training, and performance… more
- Highmark Health (Charleston, WV)
- …satisfaction, and quality outcomes. A key component of this role is to review denials of care based on medical necessity. The incumbent acts as a liaison for ... providers across the network. + Attend meetings as appropriate, including medical director meetings, QI committee and subcommittees, as assigned. + Contribute to the… more
- Nuvance Health (Danbury, CT)
- …for denials identification and remediation of root causes, submit appeals , funnel education back to responsible parties, and track success towards future ... Director Patient Access Pre-Services Location: Danbury, CT, United...denial prevention and effective appeal writing to overturn administrative denials . Provides support for de-centralized financial clearance, or act… more
- Nuvance Health (Norwalk, CT)
- …NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials . Oversees appeals , at the first level of appeal as appropriate, in ... Care Coordination Director Location: Norwalk, CT, United States Requisition ID:...management and high-risk case management. Works collaboratively with the Director of transitions to ensure optimum utilization of Social… 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
- 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
- Guidehouse (Lewisville, TX)
- …None **What You Will Do** **:** Working under the general direction of the Director or Vice President of Operations, the **Associate Director , PFS** serves as ... and operations related to billing, insurance and self-pay follow-up, denial appeals , and resolution of credits/refunds. Additionally, the position will monitor goals… more
- Insight Global (Miami, FL)
- Job Description The Director of Revenue Cycle Management is responsible for the successful management of the RCM AR Management Operations Team. The position manages ... follow-up, denial management, patient customer service, and underpayments recovery. The Director is responsible for establishing and monitoring the department goals,… more
- HCA Healthcare (Greenwood Village, CO)
- …QAPI program including chart audits and oversight of adverse events. Assists with processing appeals and denials as requested. + Provides a lead role regarding ... over 156,000 hours impacting our communities. As a Hospice Director of Clinical Services with HealthONE Hospice & Family...by location._** Come join our team as a Hospice Director of Clinical Services. We care for our communities… 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
- Houston Methodist (Katy, TX)
- …to include areas such as insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, etc. This position is ... At Houston Methodist, the Director System Revenue Cycle position is responsible for...and developing/implementing action plans to respond to fluctuations. The Director position responsibilities include overseeing the activities of the… more
