- CenterWell (Nashville, TN)
- …caring community and help us put health first** The **Denials Management Specialist ** is responsible to respond to, monitor and analyze all governmental requests, ... to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and… more
- Stryker (Nashville, TN)
- **What You'll Do:** As our **Reimbursement and Market Access Specialist ,** you'll play a key role in ensuring patient access to our innovative IVS products by ... processes-ensuring successful navigation of the billing, prior authorization, and appeals process. **Key Responsibilities:** + Respond to day-to-day reimbursement… more
- HCA Healthcare (Nashville, TN)
- …local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all ... that invests in you as an Inpatient Coding Denials Specialist ? At Parallon, you come first. HCA Healthcare has...We are looking for a dedicated Inpatient Coding Denials Specialist like you to be a part of our… more
- Adecco US, Inc. (Franklin, TN)
- Adecco is assisting a National Pharmaceutical Client in hiring for Client Services Specialist II in Franklin TN **Pay Rate:** $16.79/hour In this role, you'll manage ... **inbound and outbound calls** , process **prior authorizations and appeals ** , and ensure **accurate documentation** in a **fast-paced environment** . You'll work… more
- HCA Healthcare (Nashville, TN)
- …for benefits may vary by location._** We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide all patients with ... apply! **Job Summary and Qualifications** Seeking a Clinical Denials Coding Review Specialist , who is responsible for applying correct coding guidelines and payor… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Insight Global (Nashville, TN)
- …Provide expert guidance on CPT codes, UB04s, HICFA forms, DRGs, ICD-10, and appeals . . Address and resolve escalated claims issues and inquiries. . Collaborate with ... of Physician and Facility Claims, Audit Codes and Billing, DRGs and ICD-10, Appeals Processes . Proven experience in a leadership, supervisory or quality assurance… more
- Intermountain Health (Nashville, TN)
- **Job Description:** The Pre-Access Authorization Specialist I is responsible for accurately verifying and completing insurance eligibility, securing prior ... pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when… more
- Intermountain Health (Nashville, TN)
- …providers, clinical staff, compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding ... review, audit findings, and appeal strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more
- Cardinal Health (Nashville, TN)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes… more
- Community Health Systems (Franklin, TN)
- …and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical ... and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case management software with documentation of… more