- Banner Health (CO)
- …May be assigned to process payments, adjustments, claims, correspondence, refunds, denials , financial/charity applications, and/or payment plans in an accurate and ... assigned, reconciles, balances and pursues account balances and payments, and/or denials , working with payor remits, facility contracts, payor customer service,… more
- Houston Methodist (Houston, TX)
- …coding staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a ... At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial… more
- SSM Health (MO)
- …through process improvement. + Oversees communication and follow-up processes related to denials and appeals to ensure such activities are submitted timely, ... Coordinates with Health Information Management and Case Management leadership on con-current denials . Review denial data appeals and under payment issues and/or… more
- RWJBarnabas Health (Oceanport, NJ)
- …related field + At least five years' managed care appeal experience + Focused denials and appeals management experience required + EPIC experience is required + ... Manager, Appeals (Full- Time) Remote RoleReq #:0000200495 Category:Billing/Collections/Registration Status:Full-Time...healthcare facilities is responsible for managing technical and clinical denials and works to resolve the denials … more
- Community Health Systems (Fort Smith, AR)
- **Job Summary** Responsible for managing appeals and denials staff in processing accounts and working with designated payors to ensure proper reimbursement, ... practices and procedures required + 3-6 years Related experience in denials and appeals required + 2-4 years Supervisory experience required **Knowledge, Skills… more
- Molina Healthcare (Lincoln, NE)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers... appeals and denials . + Strong verbal and written communication skills To… more
- Molina Healthcare (Boise, ID)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving... appeals and denials . + Strong verbal and written communication skills To… 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
- Guidehouse (Birmingham, AL)
- …Medical Record + Making outbound calls to Insurance Companies to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting ... + 0-2 years medical billing and/ or payer experience working with UB04, appeals & denials . + Ability to initiate and follow through on projects and work… more
- St. Luke's Health System (Twin Falls, ID)
- …Clinical Appeals Specialist, is responsible for managing client medical denials by conducting a comprehensive analytic review of clinical documentation to ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to… more
- CommonSpirit Health (Phoenix, AZ)
- …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
- AscellaHealth (Berwyn, PA)
- …and insurance companies. + Document all activities of the Prior Authorizations and Appeals process. + Respond to Prior Authorization denials and submit ... What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate… more
- R1 RCM (Detroit, MI)
- …will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...**Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor the workflow of… more
- R1 RCM (Boise, ID)
- …, you will help our hospital clients by serving as an expert on appeals and denials management where claims were denied by either governmental contractors ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...**Here's what you will experience working as a Clinical Appeals Nurse:** + Conduct a detailed review of patient… more
- Nuvance Health (Danbury, CT)
- …leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with ... will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of collaboration,… more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… 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 ... payer work queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when necessary. + Resolves… more
- Hunterdon Health Care System (Flemington, NJ)
- …are accounted for within the master charge master file. + Tracks AR days, denials , appeals , and recommends policy and procedure changes to reduce and prevent ... for all hospital ancillary areas. Maintains best practices with registration, billing, denials , payment posting and collection follow up processes using HFMA data.… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... ensure compliance with Signature Healthcare Hospital standards, prompt notification of denials , questionable cases and cases referred for outside review. Monitors… more
- WMCHealth (Valhalla, NY)
- …expedited appeals . + Participate in peer-to-peer review with payors and/or complete appeals as required to overturn denials . + Provides assistance to initial ... to discuss cases and problems. + Participates in daily review of aggregate denials / appeals with the Medical Director, peer, or the Clinical Review Supervisor. +… more
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