- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely ... to ensure all follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for clinical appeals as… 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
- 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 PRI's (Patient Review Instrument), as needed. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties 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
- 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
- CenterWell (Denver, CO)
- …communication and presentation skills + Advanced knowledge with Payer requirements, ADR requests, Denials , Appeals , RAC/ZPIC and CERT responses + Must be able to ... community and help us put health first** The Director Denials Management provides leadership for the audit, appeal and...and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,… more
- BronxCare Health System (Bronx, NY)
- Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute ... action in order to improve outcomes. - Maintains an excel log related to denials / appeals activities in order to monitor successful appeals . - Assists with… more
- TEKsystems (Addison, TX)
- …processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials , appeals , and arbitration processes, including knowledge of ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… more
- R1 RCM (Chicago, IL)
- …Management:** Develop, implement, and maintain comprehensive policies and procedures for denials and appeals management, ensuring compliance with industry ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Denials Director** , you will act as a strategic leader dedicated… more
- BronxCare Health System (Bronx, NY)
- …for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely ... tracking and trending of all denials and appeals , prepare weekly status reports, attend necessary meetings to assist the department attain its objective of… 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 ... and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop coder education… more
- Mount Sinai Health System (New York, NY)
- …terms. + Ensure timely and appropriate communication with payers for authorization, denials , and appeals . + Collaborate with physicians and clinical teams ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals … more
- Molina Healthcare (Bothell, WA)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers,... appeals and denials . * Customer service experience. * Strong organizational and… more
- HCA Healthcare (Brentwood, TN)
- …technical denial arguments for reconsideration. + Identify contract protection to leveraged overturn denials . + Argue appeals that prevent claim payment and gain ... each individual is recognized. Submit your application for the opportunity below: Appeals SpecialistParallon **Benefits** Parallon offers a total rewards package that… more
- Beth Israel Lahey Health (Plymouth, MA)
- …status of completion. + Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow up on clinical ... a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth Israel… more
- University of Washington (Seattle, WA)
- … denials to determine next steps. Additionally, they conduct appeals as appropriate by reviewing medical necessity, and/or reconciling coverage-related issues. ... communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity reviews, based on denial root… more
- CommonSpirit Health (Englewood, CO)
- …denied claims to determine validity and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, ... needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and expectations.… more
- Guidehouse (Birmingham, AL)
- …Medical Record + Making outbound calls to Insurance Companies to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting ... or equivalent. + 0-2 years medical provider experience working with UB04, appeals & denials . **What Would Be Nice to Have** **:** + Basic computer skills.… more
- Houston Methodist (Sugar Land, TX)
- …processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD codes ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing...review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team… more
- Covenant Health Inc. (Knoxville, TN)
- …procedures, implementing new policies and procedures relative to financial services and appeals processing. + Analyzes denials and coordinates insurance ... Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full...staff with regard to clinical and medical necessity insurance denials . Analyzes all correspondence regarding insurance denials … more
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