- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE:… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and… more
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure verbal ... strict deadlines. * When necessary collaborate with care teams, clinical staff, family members, and other involved in providing...with CCA departments to help manage and resolve member appeals and grievances. * Act as a liaison between… more
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop internal… more
- MetroHealth (Cleveland, OH)
- …and experience in addition to experience noted below. Minimum of 5 years as Clinical Documentation Integrity Specialist or; - CDIP or CCDS Certification with ... departments and more than 20 health centers.** **Summary:** **Performs secondary clinical chart reviews, resolves DRG discrepancies, and educates clinical … more
- HCA Healthcare (Nashville, TN)
- **Description** **Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient and effective ... and delivery of all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group (PSG). The education… more
- Glens Falls Hospital (Glens Falls, NY)
- …but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to ... Emergency coding *Licenses, Certifications, Registrations* * o CCS, RHIT, RHIA, Certified Coding Specialist is Required o CDIP is a plus *Salary Range* The expected… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4726146) Apply Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and benefit plans including: + Competitive Pay + Medical, Dental, Vision ... Package + Fun, Family-Like Team, and Atmosphere! We are seeking an experienced Clinical Reimbursement Specialist to support our MDS/MMQ teams in Massachusetts.… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
- Insight Global (Skokie, IL)
- Job Description Insight Global is looking for a clinical denials specialist to join the team at one of your healthcare clients in Chicago. As a Clinical ... perspective. This person will be responsible for preparing appeals and communication with the clinical team members. With a strong focus on maximizing patient… more
- UTMB Health (Galveston, TX)
- Billing Specialist , Ob/Gyn Clinical Support Services (Partial Remote) **Galveston, Texas, United States** Clerical & Administrative Support UTMB Health ... Research + Reporting + Work Queue review and management + CPT Appeals + Monitor/Track Collections for Family Planning grant claims **Salary Range:** Commensurate… more
- Houston Methodist (Houston, TX)
- …Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial management and appeals process in a ... collaborative environment with revenue cycle management and clinical partners at various Houston Methodist facilities. This position will be responsible for working… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- Hartford HealthCare (Farmington, CT)
- …works collaboratively with appropriate teams to prevent future denial. . Coordinates clinical appeals process and participates in compliance investigations as ... works with others as needed to determine the appropriate course of denial appeals . . Maintains accurate, clear, timely documentation related to denied cases. .… more
- Priority Health Care (Marrero, LA)
- JOB SUMMARY: The Revenue Cycle Specialist II must adhere to the Code of Ethical Conduct and foster positive relationships within the company, across departments, and ... response from third-party payors, processing payor denials, documentation requests, and appeals , and monitoring day-to-day activities related to appeal follow-up and… more
- State of Colorado (CO)
- CDOC Addiction Specialist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4559805) Apply CDOC Addiction Specialist II Salary $5,553.00 ... CAA Statewide Addic D&A 7/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 06/27/2024 Closing Date 12/31/2024 4:00… more