- 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, ... Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within… 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 , ... related to denial turnaround times, appeal success rates, and denial reduction targets. * Denials Prevention * . Analyze denial patterns to identify root causes… more
- Stanford Health Care (Palo Alto, CA)
- … follow-up, denials appeals , denial and write-off analysis, and denials prevention . The Director operates as the enterprise expert and spokesperson for ... Denials Management serves as the strategic leader and leads all denials prevention and management activities for the Stanford Health Care enterprise… 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 ... UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of... clinical information. + Provides oversight of the … more
- CommonSpirit Health (Englewood, CO)
- …and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, crafting compelling appeal ... discuss the needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely… more
- Nuvance Health (Danbury, CT)
- …strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while ... Leader* will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of… more
- Beth Israel Lahey Health (Beverly, MA)
- …and interpersonal skills to support and represent the optimal denials prevention processes identified with all medical, clinical and ancillary departments. ... their full potential. **Job Description:** Job Description **Position Summary:** The Clinical Denials Specialist assesses, plans, coordinates, and evaluates… 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 ... third party payer work queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when necessary.… more
- Beth Israel Lahey Health (Plymouth, MA)
- …concurrent and retrospective reviews for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors * ... understanding of reimbursement systems. You will manage concurrent reviews, appeal clinical denials , and support accurate level-of-care determinations. Key… more
- Nuvance Health (Danbury, CT)
- …admission criteria for all levels of care) * Understanding of approaches to denials management * Familiarity with clinical documentation requirements * Working ... expertise related to appropriate utilization/level of care (LOC) and appropriate clinical documentation. Provides oversight for other Physician Advisors for both the… more
- HCA Healthcare (Austin, TX)
- …medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge ... managers and hospital staff in the reduction of payer denials and in the denial and appeals ...for evidence-based clinical practice, patient safety, and clinical loss prevention to facility leadership and… more
- AdventHealth (Tampa, FL)
- …claim denials to perform the appropriate resolution, rebilling, and/or appeals steps. Assists with developing and implementing strategies and procedures to ... AdventHealth Pepin Heart Institute, a recognized leader in cardiovascular disease prevention , diagnosis, treatment and leading-edge research caring for Tampa Bays… more
- Houston Methodist (Houston, TX)
- …model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention . A champion of a progressive care management model, ... position promotes innovative strategies while fostering interprofessional collaboration across clinical and administrative domains. This position leads enterprise-wide initiatives… more