- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue...Denials Management Department by managing and resolving clinical appeals related to government audits and denials .… more
- Stony Brook University (East Setauket, NY)
- Revenue Specialist **Position Summary** At Stony Brook Medicine, a **Revenue Specialist ** will provide operational support within the hospital's Patient ... business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue… more
- CommonSpirit Health (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… 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
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials ,… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information...contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of… 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 ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Medical Billing & Denials Specialist Department: Patient Financial ServicesLocation: Massena HospitalHours Per Week: 40Schedule: Monday - Friday ... 8AM-4PM SUMMARY: A Medical Billing and Denials Specialist is responsible for managing the...fee schedules, DRGs, and reimbursement procedures. + Claims and Appeals Processing: Submits and follows up on insurance claims;… 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
- Penn Medicine (East Petersburg, PA)
- …are met in an appropriate manner. Responsibilities: + Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve ... to expedite the resolution of the denied claim. + Performs all appeals and denial recovery procedures needed to appropriately and accurately resolve denied… more
- Community Health Systems (Franklin, TN)
- …and supports initiatives that improve denial prevention and recovery processes. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, ... **Job Summary** The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. This role… more
- Molina Healthcare (Everett, WA)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or... appeals and denials . * Customer service experience. * Strong organizational and… more
- Molina Healthcare (Fort Worth, TX)
- …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
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals ,...regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending.… more
- Molina Healthcare (AZ)
- …Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and requests for appeals into information system and prepares ... systems and other available resources. * Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. * Requests and obtains… more
- Molina Healthcare (AZ)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant... appeals and denials . * Customer service experience. * Strong organizational and… 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 ... of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers...RN, MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information… more
- BJC HealthCare (St. Louis, MO)
- …Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level ... About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with hospital billing.... Collaborates to develop best practices procedures to prevent denials . + Effectively communicates with the Clinical Appeals… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …status using payer portals and billing software; investigate and resolve rejections or denials promptly. + Prepare and submit appeals for denied claims, ... Job Summary The Billing Specialist plays a critical part in maintaining the...narratives as needed. + Identify and report trends in denials , underpayments, and billing errors to support performance improvement.… more
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