- 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 ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... and intensity of services provided. + Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not… 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
- Nuvance Health (Danbury, CT)
- …*Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for...appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and… more
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials ,… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information...contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of… more
- University of Southern California (Alhambra, CA)
- …federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with… more
- Fairview Health Services (St. Paul, MN)
- **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the ... pertaining to billing, coding, and documentation. The Inpatient Coding Denials Specialist will also handle audit-related and...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… more
- Fairview Health Services (St. Paul, MN)
- **Job Overview** The Physician Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the ... pertaining to billing, coding, and documentation. The Physician Coding Denials Specialist will also handle audit-related and...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… more
- Addiction Recovery Care (Lexington, KY)
- …and stewardship are key elements of everything we do! We are hiring a Denials Resolution Specialist to our growing team! Under direct supervision the ... Denials Resolution Specialist is responsible for resolving...defined communication and escalation channels. + Carry out insurance appeals + Resolves work assigned according to the prescribed… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Medical Billing & Denials Specialist Department: Patient Financial Services Location: SLH - Regional Administrative Campus Hours Per Week: 40 ... Schedule: 8am-4pm SUMMARY: A Medical Billing and Denials Specialist is responsible for managing the...fee schedules, DRGs, and reimbursement procedures. + Claims and Appeals Processing: Submits and follows up on insurance claims;… more
- Robert Half Accountemps (Minnetonka, MN)
- Description We are looking for a detail-oriented Denials Specialist to join our team in Minnetonka, Minnesota on a contract basis. In this role, you will be ... with regulations, and contributing to process improvements that minimize future denials . This position requires strong analytical skills and a thorough understanding… more
- Penn Medicine (East Petersburg, PA)
- …shape our future each day. Are you living your life's work? Job: Denials Management Specialist Hours: Day shift hours, start time between 07:00am-9:00am ... are met in an appropriate manner. Responsibilities: + Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve… more
- TEKsystems (Denver, CO)
- Medical Appeals Specialist (Fully Remote) Make a measurable impact by overturning denials , recovering missed revenue, and improving patient account outcomes. ... As a Medical Appeals Specialist , you'll combine deep payer policy...1+ year of Revenue Cycle Management experience specifically in appeals ( denials research, root‑cause analysis, and complex… 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
- UNC Health Care (Kinston, NC)
- …all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and second levels of an ... the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation… more
- Community Health Systems (Franklin, TN)
- …and supports initiatives that improve denial prevention and recovery processes. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, ... **Job Summary** The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. This role… 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
- 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)
- **Job Description:** The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance ... **Preferred** + Demonstrated experience in healthcare insurance billing, follow-up, denials and appeals or audit role. +...in healthcare insurance billing, follow-up, denials and appeals or audit role. + Bachelor's degree preferred. +… more