- CommonSpirit Health (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... role. Primary residence must be in CO, UT, or Kansas.** Must have Clinical Denials experience. Please make sure it's clearly written out in your resume. **Where… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to...including but not limited to: DRG downgrade, DRG Validation, Clinical Validation, diagnosis codes not supported, and/or general coding… 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...appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- Houston Methodist (Sugar Land, TX)
- …DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information ... opportunities to both operational and clinical stakeholders. The Senior Denials Management Specialist position collaborates with physicians, case managers,… more
- HCA Healthcare (Plano, TX)
- …opportunity. We want your knowledge and expertise! **Job Summary and Qualifications** The Clinical Denials Coding Review Specialist is responsible for ... **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want...as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. This job… more
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… 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
- Saratoga Hospital (Saratoga Springs, NY)
- HIS Denials Specialist (Inpatient) Location: Saratoga Hospital, 211 Church Street, Saratoga Springs, NY 12866 Employment Type: Full Time Shift/Schedule: 8a-4p ... About the Role We're looking for a dedicated HIS Denials Specialist to join our team and...This position provides a vital link between inpatient coding, clinical documentation improvement, Patient Access (PA) and Patient Financial… more
- Datavant (Nashville, TN)
- …realize our bold vision for healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of ... recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed… 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
- UNC Health Care (Kinston, NC)
- …Reviews all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and ... to reimbursement, denials , status, etc. 6. Evaluates clinical denials for validity and probability to...win rates. 12. Assists in documentation review in the clinical documentation specialist role when needed. Working… more
- Community Health Systems (Franklin, TN)
- … Documentation Improvement Professional required or + CCDS - Certified Clinical Documentation Specialist required Equal Employment Opportunity This organization ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA)… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... with the System Business Office related to appeals, denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and incoming fax… more
- Texas Health Resources (Arlington, TX)
- …with a top-notch health care company? We're looking for a qualified_ Coder II ( Denials ) _like you to join our Texas Health family._ Position Highlights + Work ... Certified Professional Coder Upon Hire REQUIRED or CCS-P - Certified Coding Specialist - Physician-based Upon Hire REQUIRED and Other Specialty certification such as… more
- Rochester Regional Health (Rochester, NY)
- …resolve the issues resulting in denial/underpayment and to formally appeal. The specialist will conduct comprehensive reviews of clinical documentation to ... SUMMARY The C & D specialist is responsible for reviewing accounts which have...claims processing and accounts receivable collections. The Medical collection specialist must have the Ability to learn and understand… more
- Stanford Health Care (Palo Alto, CA)
- …States of America) **This is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role ... in the Revenue Cycle Denials Management Department by managing and resolving ...as well as excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist … more
- University of Southern California (Arcadia, CA)
- …Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay ... recommendations on query structure, process, and workflow. Responds to coding denials with clinical justifications and coding conventions. Maintain… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Specialist identifies revenue opportunities and works collaboratively with Revenue Cycle ... staff to drive process improvement, educate clinical departmental staff, and document workflows. Primary areas of focus include revenue capture accuracy, decreased … more