- St. Mary's Healthcare (Amsterdam, NY)
- …government claim denials and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with ... based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items and to… more
- Diversicare Healthcare Services & Diversicare Ther (Brentwood, TN)
- …. \#BSC123 **Responsibilities** 1. Maintain an electronic tracking system for all ADRS, denials , and appeals . 2. Communicate and collaborate with centers to ... LPN) or related Healthcare field 2. Experience in SNF/LTC 3. Experience in Clinical Software Systems 4. Experience in minimum data set. (EOE) **Job ID** _2024-58468_… more
- Houston Methodist (Houston, TX)
- …staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a ... At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating... is responsible for coordinating and monitoring the coding-specific clinical charges and denial management and appeals … more
- TEKsystems (Plano, TX)
- Required: + 2+ years of Insurance follow-up, denials / appeals experience (Medical A/R) + Hospital/facility collections experience Description: Responsible for ... attorney referral. * Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing deadlines. * Communicates all… more
- McLaren Health Care (Bay City, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... education sessions to maintain competency and knowledge of regulations in denials , utilization management, care management, clinical documentation, and… more
- University of Utah (Salt Lake City, UT)
- …Number** PRN39530B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt ... -H), Certified Professional Coder-Payer ( CPC -P), Certified Coding Specialist ( CCS ), Certified Coding Specialist ...knowledge of revenue cycle. + Working knowledge of insurance denials , appeals and expected reimbursement rates. +… more
- University of Washington (Seattle, WA)
- …payer communications thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical ... FINANCIAL SERVICES Department** has an outstanding opportunity for a ** CLINICAL APPEALS AND DISPUTES NURSE** **Work Schedule**...of charge capture and coding as they relate to clinical denials ; assist revenue cycle leadership in… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... clinical documentation review to establish and manage clinical and prior authorization denial appeals for...as an internal resource for revenue cycle management on clinical matters.Reviews outpatient post payment denials when… more
- St. Luke's University Health Network (Allentown, PA)
- …clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network. Utilizes ... coding errors and MUE frequency for clean claim submission + Resolve coding denials through claim correction or appeal. Claim corrections will be made after review… more
- University of Michigan (Ann Arbor, MI)
- …of illness, expected risk of mortality, accuracy of patient outcomes, PSI90/HAC reviews, clinical denials and appeals and complexity of patient care. ... Clinical Documentation Integrity Specialist III Apply...& trial groups. + Involvement in third party audit denials and appeal processes, including but not limited to… more
- Houston Methodist (Houston, TX)
- …This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… more
- Mount Sinai Health System (New York, NY)
- …and quality issues Responsible for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). ... or Departmental Manager. In relationship to UM Insurance verification; authorizations and approvals; denials and appeals , will assist in the processing of mail.… more
- HCA Healthcare (Nashville, TN)
- …and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts ... your knowledge and expertise! **Job Summary and Qualifications** The Inpatient Coding Denials Specialist is a high-level coding expert responsible for… more
- Healthfirst (NE)
- …and resolution of non- clinical cases, such as: certain types of claim denials , member complaints, and member and provider appeals . The end-to-end process ... Work within a framework that measures productivity and quality for each Specialist against expectations + Additional duties as assigned **Minimum Qualifications** +… more
- Weill Cornell Medical College (New York, NY)
- …a Certified Professional Coder to investigate and resolve coding related insurance payment denials . The CBO partners with WCM Clinical Departments to increase ... Title: Revenue Cycle Specialist -Revenue Integrity Location: Midtown Org Unit: AR -...for their root causes thereby driving efficiencies, to include clinical documentation improvement and coding denials prevention.… more
- R1 RCM (Boise, ID)
- …you will be responsible for key operational functions to include charge capture, clinical billing, appeals and advanced third-party or government audits. Every ... level reconciliation. + Share trends related to billing and appeals from a clinical perspective, provide transformation...Minimum 3 years' revenue cycle management in back-end working denials , appeals , and billing + Knowledge of… more
- Baptist Memorial (Jackson, MS)
- Summary The Accounts Receivable Follow Up Specialist performs all collection and follow up activities with third party payers to resolve all outstanding balances and ... receivable, percentage of accounts aged greater than 90 days, cash collections, and denials resolution in support of the team efforts in the achievement of accounts… more
- Mount Sinai Health System (New York, NY)
- …entry of office, inpatient, and/or outpatient charges. Runs and works missing charges, edits, denials list and processes appeals . Posts denials on a timely ... **Job Description** The Procedural Billing Specialist III is a senior level individual, responsible for multiple components of the billing process for specialized or… more
- Hackensack Meridian Health (Hackensack, NJ)
- …j. Develop strategies across all functional departments to reduce clinical denials by: I. Peer-to Peer (P2P) Concurrent appeals ii. Written Concurrent ... **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the...and resolution of activities that assure the integrity of clinical records for the patient population and HackensackUMC. These… more
- Tufts Medicine (Tyngsboro, MA)
- …health insurers, follows up with health insurers about submitted claims, and performs appeals for non- clinical denials , etc. An organizational related ... or a role that focuses on support of daily business activities (eg, technical, clinical , non- clinical ) operating in a "hands on" environment. The majority of… more