- 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
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Nurse Manager ? At Parallon, you come first. HCA Healthcare ... make a difference. We are looking for a dedicated Clinical Appeals Nurse Manager like...information to properly formulate and evaluate clinical appeals . + Determine root cause of denials … 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
- 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
- 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
- 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. ... for employment: Minority/Female/Disabled/Protected Veteran* **Job:** **Nursing* **Organization:** ** **Title:** * Clinical Case Manager - Weekends* **Location:** *NC-Rutherfordton*… 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
- 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
- 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
- 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
- Crouse Hospital (Syracuse, NY)
- …department. Areas of authority include Utilization Management, Discharge Planning and Denials and Appeals functions. General operational oversight including ... Required: A minimum of five (5) years previous case management, utilization review, appeals and denials and discharge planning experience preferably in an acute… 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
- Sharp HealthCare (San Diego, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... **Shift End Time** Master's Degree; Bachelor's Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; Accredited Case… more
- Sharp HealthCare (San Diego, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... **Shift** Day **FTE** 0 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered… more
- Houston Methodist (Katy, TX)
- …but not limited to: insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. The ... JOB SUMMARY At Houston Methodist, the Manager Revenue Cycle position is responsible for the...external partners. (EF) 5. Analyzes operations to avoid unnecessary denials and write-offs (financial), decrease agings and identify problematic… more