- Stanford Health Care (Palo Alto, CA)
- …Complete all assigned tasks by established deadlines and communicate proactively with the Manager of Government Audit and Appeal regarding any potential ... Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays...support appeals. + Collaboration with Management: Identify and escalate denial patterns to the Manager of Government… more
- Guthrie (Sayre, PA)
- Summary The Denial , Appeal , and Audit Manager is responsible for the oversight and management of all payer denials, appeals, and audit processes ... claim denials, effective appeal strategies, and proactive audit response. The manager leads a team...dashboards and reports to track denial rates, appeal success rates, and audit recoveries +… more
- Beth Israel Lahey Health (Beverly, MA)
- …in practice and or documentation of the providers to promote a reduction in the denial 's trends. The denials specialist collects and trends the data as it relates to ... denials and reports that data to the Manager of Case Management for review. The Clinical Denials...recommendation for responding or not responding to the denials. Appeal payment of services denied by Medicare, Medicaid, and… more
- BronxCare Health System (Bronx, NY)
- …staff, the Appeal Manager is responsible to develop a strong appeal letter that will result in the denial being overturned providing the hospital ... the care and services provided to the patient. The Denial Manager will assist the department's leadership...staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal and… more
- Sharp HealthCare (San Diego, CA)
- …integrations that ensure billing compliance related to data claims submission, appeal and audit functions, clinic chargemasters, testing and implementation ... excellence. Direct Reports include Manager of Professional Revenue Cycle, Manager Accounts Receivable/Quality Control AR/QC, Denial Management, and Financial… more
- HonorHealth (AZ)
- …with level of care and length of stay management, assists with the denial management process, reviews and makes suggestions related to resource and service ... is not available, discusses the process for issuance and appeal to the physician. Documents patient care reviews, decisions,...Care Management in a data-driven approach. Notifies the care manager of any conflict of interest in reviewing a… more
- University of Southern California (Alhambra, CA)
- …determining the need for appeal . Performs all 1st and 2nd level coding-related denial appeals. All tasks & duties to be perform in compliance with federal & ... IP & OP healthcare services provided to covered patients. Manages the denial management process for coding-related denials, triage denied claims to distinguish… more
- Guthrie (Sayre, PA)
- …Insurance Billing Specialists I and related support staff. Works closely with Director, Manager , Supervisor and Application Analyst on day to day priorities and to ... to determine specific issues and patterns that need to be addressed. Serves on Denial Task Force(s) and assists in developing action plans to reduce denials and… more
- Molina Healthcare (Salt Lake City, UT)
- …proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... by another Molina department to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by… more
