- Sun Pharmaceuticals, Inc (Washington, DC)
- …expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals , exceptions, denials , coding and payer payment guidelines, ... Field Reimbursement Manager Overview: The Field Reimbursement Manager is part of the Market Access group supporting Suns family of branded products in the United… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree 2 years of experience - hospital billing, processing claim edits, denials , appeals and managing accounts receivable. Experience with Epic Resolute ... CHFP (Certified Healthcare Financial Professional) CPAM (Certified Patient Account Manager ) CPAT (Certified Patient Account Tech) **The current salary range… more
- BronxCare Health System (Bronx, NY)
- …best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials ... Overview The Appeals Manager is responsible to assist...to assist the department attain its objective of managing denials and appeals . Responsibilities -Types, utilizing a… more
- Garnet Health (Middletown, NY)
- …is responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate ... overall quality, completeness, and accuracy of medical record documentation. The Manager will evaluate denials and work closely with the outcomes manager and… more
- Hartford HealthCare (Farmington, CT)
- …review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... multiple denials , prioritize tasks, and ensure timely submission of appeals . . Experience with electronic health record (EHR) systems, coding software, and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs...Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow… more
- University of Southern California (Alhambra, CA)
- …& state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related ... 'claims denials ' and 'claims rejections,' specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS,...appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in… more
- Addiction Recovery Care (Lexington, KY)
- …and stewardship are key elements of everything we do! We are hiring a Denials Resolution Specialist to our growing team! Under direct supervision the Denials ... + Conducts root cause analysis of all assigned insurance payer claims and denials to determine appropriate actions required to resolve the claim / denial into… 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
- 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. ... thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity reviews, based… more
- Penn Medicine (East Petersburg, PA)
- …shape our future each day. Are you living your life's work? Job: Denials Management Specialist Hours: Day shift hours, start time between 07:00am-9:00am (8 hour ... 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
- Omaha Children's Hospital (Omaha, NE)
- …management for insurance and government collections to include claims, A/R follow-up, denials and appeals . This includes supervising, monitoring, and analyzing ... **Schedule: FT, Days, denials exp required (flexible hours)** At Children's Nebraska,...policies, regulatory, and legal requirements. + Assisting the department manager in the implementation of the strategic direction within… more
- Guthrie (Sayre, PA)
- …Audit Manager is responsible for the oversight and management of all payer denials , appeals , and audit processes within the health system. This role ensures ... or insurance with responsibility and management of billing and reimbursement. Essential Functions Denials & Appeals Management + Oversee daily operations of the … more
- NTT America, Inc. (Plano, TX)
- …and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. NTT DATA is seeking to hire a **Medicare ... Appeals Clinical Leader** to lead service delivery engagements and...interpret medical records, documenting recommendations to uphold or overturn denials + Excellent analytical and problem-solving skills + Strong… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...limited to the following: accounts receivable days, cash collections, denials , avoidable write-offs, staff productivity and work quality and… more
- HCA Healthcare (Nashville, TN)
- …requests for intervention from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of care, decisions about ... have the career opportunities as a Quality Control Senior Manager you want with your current employer? We have...and address payer medical policies that lead to inappropriate denials , advocating for fair and accurate coverage. + Provide… 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
- Fallon Health (Worcester, MA)
- …regarding the grievance/appeal. + Acts as the initial investigator for provider appeals related to filing limit, claim denials , claim payment, retrospective ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …Office is opened daily and comments are entered in the system for authorization, denials and EOB's timely, scanned in DoclLnk and filed in monthly Business Office ... folder. + Discuss denials with UR staff and update Denial Tracker accordingly....prepare patient or insurance refund. + Request charts, prepare appeals and charts for mailing, documenting Denial Tracker in… more
- Sharp HealthCare (San Diego, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's Degree in Nursing;… more
