- Stanford Health Care (Palo Alto, CA)
- …in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials . This position ... with Management: Identify and escalate denial patterns to the Manager of Government Audits and Appeals , providing...regulations, payor policies, and industry best practices related to clinical appeals and denials management.… more
- Sun Pharmaceuticals, Inc (Washington, DC)
- …expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals , exceptions, denials , coding and payer payment guidelines, ... Field Reimbursement Manager Overview: The Field Reimbursement Manager ...and quality programs related to value based care and clinical care pathways. Responsibilities include: + Incorporate knowledge of… more
- Hartford HealthCare (Farmington, CT)
- …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… more
- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who...UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of… more
- University of Southern California (Alhambra, CA)
- …for coding-related denials , triage denied claims to distinguish coding-related denials versus clinical -related denials , evaluating claims deemed ... & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related… more
- BronxCare Health System (Bronx, NY)
- …best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials ... and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible...to assist the department attain its objective of managing denials and appeals . Responsibilities -Types, utilizing a… 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 billing experience working with UB04, appeals & denials . **What Would Be Nice… more
- Penn Medicine (East Petersburg, PA)
- …Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn ... 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
- Providence (Torrance, CA)
- **Description** ** Appeals RN - Care Manager Remote. This position is Per Diem and will work 8-hour, Day shifts.** The Care Management Recovery Advocate (CMRA) is ... acute care). + 2 years Experience as a case manager in an acute care setting. **Preferred Qualifications:** +...Upon hire: Case management certification. + Experience working with denials and appeals in/for an acute care… more
- Beth Israel Lahey Health (Beverly, MA)
- …data to the Manager of Case Management for review. The Clinical Denials Specialist utilizes nursing knowledge, information science, and interpersonal skills ... their full potential. **Job Description:** Job Description **Position Summary:** The Clinical Denials Specialist assesses, plans, coordinates, and evaluates… more
- Garnet Health (Middletown, NY)
- …is responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate ... The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials … more
- Guthrie (Sayre, PA)
- …and root causes; develop strategies to reduce preventable denials + Ensure appeals are written and submitted timely, with clinical accuracy and regulatory ... Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management...responsible for the oversight and management of all payer denials , appeals , and audit processes within the… more
- Cherry Tree Dental (Green Bay, WI)
- Clinical Office Manager I - Dental Designs, a Cherry Tree Dental Office Green Bay, WI Full-Time, Exempt Dental Designs, a Cherry Tree Dental office, is seeking a ... Full-Time, Exempt Clinical Office Manager I to help lead...Process insurance payments, submit claims, and follow up on denials , appeals , and additional documentation requests. +… more
- Genesis Healthcare (Los Angeles, CA)
- …to reduce AR/DSO and outstanding clinical accounts as needed and generates clinical appeals when necessary. 15. Assists with and completes special projects ... while making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical , administrative, and… more
- Trinity Health (Nampa, ID)
- …and the highest quality of care. We are looking to hire a ** Clinical Resource Manager ** for our Medical Center in Nampa, Idaho ... that can't be beat. **About this position:** As a Clinical Resource Manager you will provide concurrent...by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor… more
- NTT DATA North America (Plano, TX)
- … to join our team. NTT DATA is seeking to hire a **Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end delivery… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN… more
- HCA Healthcare (Nashville, TN)
- …and expertise! **Job Summary** We are seeking a diligent and experienced Senior Manager , Clinical Review, Quality Control to ensure the quality and accuracy ... compliance team, and enhancing the overall quality of our clinical processes. The Senior Manager will analyze...intervention from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...limited to the following: accounts receivable days, cash collections, denials , avoidable write-offs, staff productivity and work quality and… 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
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