- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …Manage department budget, staffing, and training needs. Function as Utilization Review/ Denials Manager as required. Qualifications Registered Nurse (RN) with a Texas ... license; relevant certification (CCM, ACM, CCM-RN) preferred. Proven leadership experience in acute care, utilization review, case management. Strong working knowledge of hospital billing, managed care systems, and discharge planning. Excellent skills in… more
- American Hospice and Home Health Care Services (Pleasanton, CA)
- …(EOBs) and electronic remittance advice (ERAs) to identify payment trends and denials . Research and appeal denied or underpaid claims as necessary. Verify insurance ... Brightree, Kareo, or similar platforms). Proficient in interpreting EOBs, claim denials , and HCPCS coding. Strong attention to detail and excellent organizational… more
- Columbia University (Fort Lee, NJ)
- …and accuracy. Responsibilities Accounts Receivable Coding Research root causes of claim denials and apply knowledge of payer policies to determine appropriate course ... Reviews charge correction requests and ensures accuracy prior to resubmission. Denials Management Collaborates with Accounts Receivable staff to resolve denied or… more
- Ensemble Health Partners, Inc. (Greenville, SC)
- …Understanding of Revenue Cycle including admission, billing, payments, and denials . Comprehensive knowledge of patient insurance process for obtaining authorizations ... and benefits verification. Knowledge of Health Insurance requirements. Knowledge of medical terminology or CPT or procedure codes Join an award-winning company Five-time winner of "Best in KLAS" 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle… more
- Amgen, Inc. (Philadelphia, PA)
- …troubleshoot and resolve initial and ongoing reimbursement issues (PAs, denials , appeals, reauthorizations, overrides, billing problems) Liaise with medical offices ... as necessary to obtain insurance authorizations Counsel patients and family on insurance and reimbursement options Identify general and specific adherence trends and suggest appropriate action Report on weekly changes in patient status, current adjudication… more
- American Family Care (Panama City Beach, FL)
- …Meticulously verify coverage BEFORE services are provided, prevent claim denials , and maximize revenue capture Excel at Financial Counseling: Confidently ... explain costs, billing processes, and insurance complexities to patients in a way they understand Solve Billing Problems: Proactively identify and resolve insurance discrepancies and billing issues before they impact revenue Drive Patient Satisfaction: Deliver… more
- Fraser (Minneapolis, MN)
- …Processing refunds, billing corrections, and monitoring and responding to billing denials in a timely manner. Identifies, monitors and recommends resolutions to ... potential issues arising from accounts receivables. Pursues payments from third party carriers and patients. Sets up financial agreements with patients/families. Maintains a close collaboration with the Accounting Department. Assists with resolving… more
- Precision Castparts Corp. (Auburn, WA)
- …Audit suppliers either on-site or through desk audits. Recommend approvals and/or denials of suppliers Quality systems. Work directly with Purchasing to select or ... improve suppliers. Document supplier performance. Monitor QMS policies and procedure's effectiveness through teamwork and statistical methods; Recommend improvements; Support QMS training. Audit Quality systems for deficiency identification and correction.… more
- AssuredPartners (Columbus, OH)
- …manage difficult client communications including loss of coverage, claim denials , unfavorable underwriting and other challenging renewal scenarios. Account ... Management Negotiate and sell lines of insurance to clients to round out accounts as appropriate. May design insurance and risk management plans for clients as assigned an directed by Agency management. Own all audit, review and claims processes for assigned… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …appropriate adjudication of prior authorization. Directly reviews all medical necessity denials and modifications of a prior authorization requests. Ensures the ... creation, modification, and appropriate and timely use of UM criteria for both inpatient and outpatient authorizations. Identifies and develops opportunities for innovation to increase effectiveness and quality. Ensures that assigned patients have access to… more
- Beloit Health System (Beloit, WI)
- …timely claim submission Obtain fiscal resolution of no pay/overpayment determinations( denials ) through appeal Analyze payor claims processing and reimbursement to ... contractual obligations to ensure facility is receiving proper payment for services Document all work in accordance with departmental standards Requirements include: High school diploma or equivalent 2+ years' experience (within the last 3 years) of Medicare… more
- Aveanna Healthcare (Brandon, FL)
- …or instruction. Documents effectively resulting in no technical or clinical denials subsequent to review of documentation by payers Maintain effective communication ... between staff, healthcare team members and family. Serve as a resource consultant for clinical staff. Supervises other personnel (PTA, HHA) as applicable. Completes OASIS assessments where allowed by state professional practice and regulation. Follow policies… more
- Anaheim Terrace Care Center (Anaheim, CA)
- …performance statistics including customer flow, pending and lost inquiries, denials , hospital discharges and sales activity. Facilitate sales opportunities for ... referring hospitals by identifying, initiating, nurturing and maintaining contact with physicians, social workers, discharge planners as it relates to individual center as well as center cluster; work with Administrator and Regional Marketing to follow up, as… more
- Rogers Behavioral Health (Milwaukee, WI)
- …and maintaining positive working relationships with all contracted payors. Review of all denials of service from all payors that are deemed for medical reasons. ... Interface with referring parties, the psychiatrist, primary care Physicians or AHPs, to coordinate care, aftercare. Market Employer as appropriate, to include off-site meetings and marketing activities. Review potential admissions, pending cases, and declined… more
- Windsor Healthcare (Oakland, CA)
- …Includes specific, objective measurable goals. Managing Medicare Medical Review and Denials process in conjunction with Director of Rehabilitation, the facility ... team, and therapy staff. Acquiring and documenting consents/approvals for treatment when necessary. Consistently demonstrates facility's interdisciplinary approach to patient care. This includes but is not limited to: Integrating findings of other members of… more
- NewVista Behavioral Health (Cincinnati, OH)
- …end admissions issues, outstanding AR balances, billing issues, insurance issues, and denials . This position will be focused on building relationships and collecting ... balances from nursing facilities, SNF's, hospice, and other hospitals who use Lynx EMS to transport patients. Requirements: High School Diploma or GED equivalent Prior healthcare billing experience highly preferred Prior experience in customer service or call… more
- Nemours Children's Health (Pensacola, FL)
- …Provides appropriate documentation that meets insurance company requirements; appeal all denials in a timely manner. Participates in inpatient and outpatient ... consultation for specialty including on-call. What We Offer No state income tax in Florida Competitive base compensation Annual incentive compensation that values clinical activity, academic accomplishments and quality improvement Comprehensive benefits:… more
- Sun Communities, Inc. (Ocala, FL)
- …to obtain approvals on prospective resident applicants; tracks all approvals and denials Prepares bank deposit slips and deposit funds as required; makes daily ... bank runs as needed Other duties as assigned Requirements High School Diploma or GED (Required) 2 years in administrative experience (Required) 6 months in property management office experience (Preferred) 6 months in previous NetSuite experience (Preferred)… more
- Liberty Health (Wilmington, NC)
- …to coding, medical records/documentation, pre-certification reimbursement and claim denials /appeals Use critical thinking and problem-solving to navigate through ... the complexities of the Managed Care program guidelines. Ability to focus on interventions for improvement Provides appropriate responses to providers regarding UM questions, or request the assistance of the UM RNs or Direct of Utilization Management. Assist… 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 ... and payers to successfully clear front end claim edits, appeal clinical denials , and address customer service inquiries. Additionally, this position will collaborate… more
