- 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
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely ... HMS, Hyland, BARRT) to ensure all follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for… 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 (Los Angeles, 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
- Fairview Health Services (St. Paul, MN)
- **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the ... pertaining to billing, coding, and documentation. The Inpatient Coding Denials Specialist will also handle audit-related and...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… 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 infusion .... Collaborates to develop best practices procedures to prevent denials . + Effectively communicates with the Clinical Appeals… 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
- Rochester Regional Health (Rochester, NY)
- Job Title: Medical Billing and Denials Specialist Department: Revenue CycleLocation: SLH - Regional Administrative CampusHours Per Week: Per Diem Schedule: ... Between 8am-4pm SUMMARY: A Medical Billing and Denials Specialist is responsible for managing the...accurate account resolution in line with payer requirements. + Appeals & Reimbursement Review: Conduct detailed reviews of denied… 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
- Robert Half Office Team (Carmel, IN)
- Description Join our dynamic healthcare team as a Medical Denials Specialist , where you will play a vital role in resolving denied medical claims efficiently and ... Friday, 8:00 am - 5:00 pm Primary Responsibilities: + Review insurance denials and conduct thorough research to resolve outstanding claims. + Analyze patterns… more
- HCA Healthcare (Brentwood, TN)
- …**_Note: Eligibility for benefits may vary by location._** We are seeking an Appeals Specialist for our team to ensure that we continue to ... want you to apply! **Job Summary and Qualifications** The Appeals Specialist will be responsible for performing...for reconsideration. + Identify contract protection to leveraged overturn denials . + Argue appeals that prevent claim… 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
- UNC Health Care (Kinston, NC)
- …all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and second levels of an ... the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation… 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
- TEKsystems (Addison, TX)
- …terminology,medical biller,anesthesia Additional Skills & Qualifications - Proven experience as an Appeals Specialist or in a similar role within a healthcare ... processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials , appeals , and arbitration processes, including knowledge of… more
- Molina Healthcare (Doral, FL)
- …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
- 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
- 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
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