- CommonSpirit Health (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- WMCHealth (Valhalla, NY)
- Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: ... Details: Job Summary: Decrease the monies lost to insurance companies due to denials . Generate appropriate appeals , both retrospective and concurrent, based on… more
- Community Health Systems (Franklin, TN)
- …in Artiva, HMS, Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to ... for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal departments, and… more
- Nuvance Health (Danbury, CT)
- …Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and incoming fax queue. 10. Reviews ... Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders in ensuring… more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the... and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- Stanford Health Care (Palo Alto, CA)
- …performance, and continuous optimization of key Revenue Cycle multiple functions including denials follow-up, denials appeals , denial and write-off analysis, ... **A Brief Overview** Reporting to the VP, Patient Financial Services, the Director, Denials Management serves as the strategic leader and leads all denials … more
- Hartford HealthCare (Farmington, CT)
- …review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... multiple denials , prioritize tasks, and ensure timely submission of appeals . . Experience with electronic health record (EHR) systems, coding software, and… more
- McLaren Health Care (Mount Pleasant, MI)
- …responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- BronxCare Health System (Bronx, NY)
- Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute ... action in order to improve outcomes. - Maintains an excel log related to denials / appeals activities in order to monitor successful appeals . - Assists with… more
- R1 RCM (Boise, ID)
- …Management:** Develop, implement, and maintain comprehensive policies and procedures for denials and appeals management, ensuring compliance with industry ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Denials Director** , you will act as a strategic leader dedicated… more
- Community Health Systems (Franklin, TN)
- …the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education ... and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop coder education… more
- BronxCare Health System (Bronx, NY)
- …for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely ... tracking and trending of all denials and appeals , prepare weekly status reports, attend necessary meetings to assist the department attain its objective of… more
- Omaha Children's Hospital (Omaha, NE)
- …management for insurance and government collections to include claims, A/R follow-up, denials and appeals . This includes supervising, monitoring, and analyzing ... **Schedule: FT, Days, denials exp required (flexible hours)** At Children's Nebraska, our mission is to improve the life of every child through exceptional care,… more
- Molina Healthcare (San Antonio, TX)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or... appeals and denials . * Customer service experience. * Strong organizational and… more
- Mount Sinai Health System (New York, NY)
- …terms. + Ensure timely and appropriate communication with payers for authorization, denials , and appeals . + Collaborate with physicians and clinical teams ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals … more
- Mayo Clinic (Rochester, MN)
- …defend coding-related denials . Experience in utilization review, case management, denials and appeals , revenue cycle, or prior authorization preferred. ... review, and levels of care criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge and use… more
- Intermountain Health (Montgomery, AL)
- …insurance laws **Preferred** + Demonstrated experience in healthcare insurance billing, follow-up, denials and appeals or audit role. + Bachelor's degree ... **Job Description:** The RCO Appeals Specialist is responsible for researching and appealing...Advisor and works with them to obtain support for appeals . + Collaborates with Care Management, Physician Advisors, Revenue… more
- Molina Healthcare (Kenosha, WI)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant... appeals and denials . * Customer service experience. * Strong organizational and… more
- CommonSpirit Health (Englewood, CO)
- …denied claims to determine validity and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, ... needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and expectations.… more
- TEKsystems (Denver, CO)
- …+ Minimum of 1+ year of Revenue Cycle Management experience specifically in appeals ( denials research, root‑cause analysis, and complex payer follow‑ups over the ... Medical Appeals Specialist (Fully Remote) Make a measurable impact by overturning denials , recovering missed revenue, and improving patient account outcomes. As… more