- Accounting Now (Pinellas Park, FL)
- …and/or paper claims, monitoring claim status, researching rejections and denials , documenting related account activities, posting adjustments and collections of ... companies on unpaid insurance accounts identified through aging reportsAble to identify an appeals worthy claim and or ability to process appeals online or… more
- Option Care Health (Phoenix, OR)
- …patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the ... with Billing and Collection Training and completes "second level" appeals to payers.Hours: as early as 6am -8am PSTJob...48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for… more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials / appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for ... issues on accounts. Including but, not limited to Managed Care, Reimbursement, Clinical , Admissions, Facility Business Office Manager , Coding, Case Management,… more
- University of Utah (Salt Lake City, UT)
- …these attributes too. **Job Summary** Under the direction of the Quality Assurance Manager , the Medical Coding and Denials Educator is responsible for providing ... billing regulations, and payer processes related to coding policy, medical necessity, denials and appeals . 10. Research and evaluate coding, documentation… more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non- Clinical Appeals + Assisting Supervisor/ Manager as needed with various ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...+ 0-2 years medical provider experience working with UB04, appeals & denials . **What Would Be Nice… 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
- 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 ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...the process; assumes the responsibility for coordinating and appealing clinical denials per department policy; develops any… more
- The Cigna Group (Nashville, TN)
- …regarding Medicare appeals and related issues, implications and decisions. The Appeals Processing Analyst reports to the Supervisor/ Manager of Appeals ... appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- Providence (Irvine, CA)
- …with payer representatives and monitor outcomes of follow-up activities. Works closely with the Clinical Denial RN on nuances associated with denials of a ... **Description** **Claims Appeals Representative \*Remote * Candidates in AK, WA,...responsible for day-to-day review, coordination and management of technical denials requiring background and understanding from a provider operational… more
- Children's Mercy Kansas City (Kansas City, MO)
- …necessity review functions utilizing InterQual and/or MCG screening guidelines, and oversight of clinical denials / appeals . The Manager of Utilization ... the lives of children beyond the walls of our hospital. Overview The Manager of Utilization Review will provide leadership to integrated inpatient teams and assist… more
- WMCHealth (Warwick, NY)
- …. + Supervises and coordinates the activities associated with billing, follow-up, and denials and appeals . + Works with staff, payer representatives, vendors, ... formulates denials resolution strategies. + Works with the Follow-up Manager to establish and monitor accounts receivable management and cash collection… more
- LifePoint Health (Rutherfordton, NC)
- …payer guidelines and financial implications of discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. ... **Job:** **Please select a valid job field* **Organization:** ** **Title:** * Clinical Case Manager - Weekends* **Location:** *NC-Rutherfordton* **Requisition… more
- The Cigna Group (Bloomfield, CT)
- …, administrative and regulatory criteria for reviewing and making decisions on all non- clinical appeals and validating the accuracy of all received information + ... appeals and related issues, implications and decisions. The Appeals Reviewer reports to the Supervisor/ Manager of...appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials… more
- Houston Methodist (Houston, TX)
- …services. This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in ... Supervisor. + Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… 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
- Beth Israel Lahey Health (Burlington, MA)
- …operations as they relate to Epic build decisions, in-depth analysis of denials , complex appeals , audits, credits, cash, coding, workflows, data collection, ... of America) Under the managerial oversight of the Senior Manager , the Revenue Performance Analyst serves as a primary...their respective teams with a goal to accurately process appeals and reduce denials . 20. Representation at… more
- Hartford HealthCare (Southington, CT)
- …improve clinical documentation **Ensures standard work minimizes risk for denials **Participates in quality assurance audits, audits, appeals and committees ... their clients' families. Basic Purpose of the Position: **Manages appeals at the branch level including clinical ...best practices for the agency. **For clinicians identified by Clinical Team Manager and Clinical … more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… more
- Houston Methodist (Houston, TX)
- …and written communication. (EF) 2. Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional...support to other team members as advised by the manager and/or supervisor. (EF) SERVICE - 10)% 1. Completes… more
- Billings Clinic (Billings, MT)
- …on medical necessity and/or payer authorization discrepancies *Communicates to Case Manager on current outliers, potential outliers, and denials *Identifies ... and/or continued stay *Proactively interacts with payers and proactively sends clinical reviews to prevent inpatient denials *Proactively communicates with… more
