- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as ... well as Support staff managing all areas of clinical claim pre and post audit , appeals...ensure the denial department provides subject matter expertise around clinical denial management . This position will also… more
- AdventHealth (Altamonte Springs, FL)
- …Full-time; Monday-Friday **Job Location** : Remote **The role you'll contribute:** The Denials Management Coding Specialist is high level coding expert ... from payers, preventing lost reimbursement and promoting denial prevention. The Denials Management Coding Specialist addresses both Inpatient and Outpatient… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit ... industry clinical guidelines, evidence-based medicine, local and national medical management standards, and protocols + Performs ad hoc audits and reporting per… more
- Cleveland Clinic (Cleveland, OH)
- …of Finance Case Managers + Compiles monthly quality audit reports for management + Provides feedback to the Clinical Denial Leadership Team regarding process ... accessible as a subject matter expert for CCHS regarding clinical denials , payer policies and clinical...nature. **Work Experience:** + Minimum of 5 years of Clinical Denial or Utilization Management experience required.… more
- Trinity Health (Livonia, MI)
- …Shift **Description:** **REMOTE WORK BASED POSITION** **POSITION PURPOSE** The Manager Clinical Documentation Improvement and Charge Capture provides management ... This position also ensures that charges are appropriately captured in the clinical setting with the scope of responsibility extending from physician to acute… more
- Beth Israel Lahey Health (Burlington, MA)
- …or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective ... and all contracting related problems. 21. Responsible for appealing and defending claims denials , adverse audit results, and sanctions. 22. Analyzes work queues… more
- Healthfirst (PA)
- …+ Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal ... correspondence to ensure all elements of the letter match what is in the Clinical system (TruCare) and ensure the correct template is being used appropriately. +… more
- Healthfirst (NY)
- …Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and ... to ensure all elements of the letter match what is in the Clinical system (TruCare) and ensure the correct template is being used appropriately. Collaborate… more
- Hackensack Meridian Health (Hackensack, NJ)
- …determinations. Gathers and evaluates the information for appeals of Managed Care audits, clinical and technical denials by utilizing various Epic and legacy ... at **Hackensack Meridian** **_Health_** includes: + Reviews all retroactive denials in the Epic work queues to assess and...Management . + Collaborates with third party payers and clinical service lines as needed and provides clinical… more
- The Cigna Group (Nashville, TN)
- …Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate ... Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B...services as well as Part B drugs. The Case Management Analyst will be responsible for analyzing and responding… more
- Scottish Rite for Children (Dallas, TX)
- …will perform audits and reviews of departmental charge capture and reconciliation, denials management for all campuses, daily reporting and coordinated work ... manner + Ensure revenue integrity functions, including charge capture, denials management , unbilled claims, and maintenance of...or more years of experience in a hospital or clinical setting with revenue integrity audit and… more
- UCHealth (Denver, CO)
- …may be a 100% work-from-home opportunity but you must reside in Colorado. Department: UCHlth Denials Management Payer Audit FTE: Full Time, 1.0, 80.00 hours ... to documentation, and provides feedback for process opportunities. Responsibilities: + Writes clinical appeals to payors to recover denials . Coordinates with… more
- University of Michigan (Ann Arbor, MI)
- …Direct and coordinate all activities related to the response to external audit activities, appeals, and denials . Work with stakeholders to create ... proactive systems that will reduce the risk of future denials . Oversee the operational functions that require a comprehensive knowledge of organizational development… more
- Colorado State University (Fort Collins, CO)
- …commitment to diversity and inclusion. Essential Duties Job Duty CategoryDaily Clinical Coding Review/ Audit Duty/Responsibility + Ensures the proper utilization ... and consultant to all medical and ancillary staff on clinical coding, including the proper assignment of codes for...Job Qualifications Education + Associates degree in Health Information Management Experience + Two years of experience working as… more
- Universal Health Services (Dearborn, MI)
- Responsibilities Utilization Management Case Manager Beaumont Behavioral Health (a UHS Facility) A growing 144-bed behavioral health facility - Beaumont Behavioral ... information, please visit our website: https://beaumontbh.com/ PositionSummary The Utilization Management Case Manager is primarily responsible for organizing and… more
- Henry Ford Health System (Wyandotte, MI)
- …outcome management system. + Completes yearly CMS-mandated fiscal intermediary audit including collection and transmittal of required information in an accurate ... CMS on every rehab patient. + Receives all CMS denials for inpatient rehab; tracks all denials ...Collaborates with attending physiatrist, as needed, to construct the clinical rationale. Ensures all timeframes are met at each… more
- Beth Israel Lahey Health (Burlington, MA)
- …expected by Revenue Cycle Leadership. 4. Responsible for appealing and defending claims denials , adverse audit results, and sanctions. 5. Analysis, track and ... or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective… more
- Houston Methodist (Katy, TX)
- …**FINANCE ESSENTIAL FUNCTIONS** + Assists management as needed to implement audit findings to reduce compliance errors, avoidable denials , recoupments, and ... staff as needed, updating policies and procedures relative to audit findings and recommendations as indicated by management...that operate at the system level to help enable clinical departments to provide high quality patient care. Houston… more
- HCA Healthcare (Brentwood, TN)
- …and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. What you will do in this ... We want your knowledge and expertise! **Job Summary and Qualifications** As a Denials Coding Review Specialist, you will be responsible for applying correct coding… more
- LogixHealth (Bedford, MA)
- …fast-paced, collaborative environment and will bring your expertise to review and audit processing, posting, refunds and adjustments for all transactions within the ... Cash Management department. The ideal candidate will have strong technical...directly with the Billing Team to resolve issues and denials through research and assigned projects + Establishes relationships… more