- CommonSpirit Health (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management ... third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of...must be in CO, UT, or Kansas.** Must have Clinical Denials experience. Please make sure it's… 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, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld… 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 , ... **Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:**… more
- Houston Methodist (Sugar Land, TX)
- …and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical...cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or… 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 ... denials , triage denied claims to distinguish coding-related denials versus clinical -related denials , evaluating...will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... needed for workflow or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and… more
- McLaren Health Care (Mount Pleasant, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... education sessions to maintain competency and knowledge of regulations in denials , utilization management, care management, clinical documentation, and… more
- BJC HealthCare (St. Louis, MO)
- …Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist...prevent denials . + Effectively communicates with the Clinical Appeals team and works with contracted… 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
- 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 ... quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop… more
- 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 ... skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with ...regulations, payor policies, and industry best practices related to clinical appeals and denials management.… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers… more
- University of Utah (Salt Lake City, UT)
- …account resolution of MAC 1 & 2 team members. + Monitor and resolve denials and appeals to ensure timely collection. + Maintain work queue expectations. ... PRN43493B **Job Title** Medical Coders **Working Title** Medical Appeal & Coding Specialist **Career Progression Track** S00 **Track Level** S3 - Skilled **FLSA… more
- Mount Sinai Health System (New York, NY)
- …facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials . ... **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position...Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support… more
- UCLA Health (Los Angeles, CA)
- …statuses, tracking cases and maintaining updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each ... and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses...knowledgeable, detail-oriented professional with: + Bachelor's degree in a clinical or related field, or equivalent training and experience… more
- Guthrie (Sayre, PA)
- Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as a group leader by participating in staffing and employment issues. ... Serves as a resource specialist within the department. Trains Insurance Billing Specialists I...to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing procedures to… more
- CaroMont Health (Gastonia, NC)
- …Care Management and Senior management as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends ... appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process....appeals as part of denial process. The UR Specialist will be cross trained to work for the… more
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