- 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 ... with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role… more
- Community Health Systems (Franklin, TN)
- …1-3 years of experience in medical billing, revenue cycle, or claims denials and appeals processing required + Prior experience with revenue cycle processes ... **Job Summary** The Denials & Appeals Coordinator is responsible...Skills and Abilities** + Strong knowledge of payer guidelines, medical billing practices, and appeal processes. + Proficiency in… more
- Northwell Health (Melville, NY)
- …the third party payer. + Prepares and defends level of care and medical necessity for assigned case. + Collaborates with physician advisor, payor representative and ... + Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… 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 ... to make appropriate decisions and is accountable for reviewing denials for level of care, medical necessity,...and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information… 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 ... addition, this position will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with escalated issues. Essential… 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
- 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 ...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 ...accurate account resolution in line with payer requirements. + Appeals & Reimbursement Review: Conduct detailed reviews of denied… 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
- 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 ... healthcare administration or related field preferred. + Minimum 2 years' experience in medical billing, denials management, or health insurance claims. + Strong… 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 ... appeals demonstrating accuracy/proficiency in referencing support from the medical recorddocumentation and coding guidelineswith timely and successful submissions.… 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)
- …appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per ... subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for… more
- UNC Health Care (Kinston, NC)
- …Advisor and Case management Assistants. 4. Reviews and documents findings on all medical necessity and status denials . 5. Works closely with Patient Financial ... the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first...Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support… 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 ... needed for workflow or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and… more
- TEKsystems (Addison, TX)
- …medical biller,anesthesia Additional Skills & Qualifications - Proven experience as an Appeals Specialist or in a similar role within a healthcare setting. ... 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)
- …clinical denials to determine next steps. Additionally, they conduct appeals as appropriate by reviewing medical necessity, and/or reconciling ... payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity reviews, based on denial root cause,… 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 ... references for CHS hospitals via scanned, electronic and hybrid medical records. Based on review findings, writes appeal letters...of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers… more
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