- 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 ... payer utilization review departments in attempts of obtaining authorizations and claim payment. * Establishes and maintains positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with utilization… more
- SSM Health (OK)
- …IL, MO, OK, or WI)* Qualifications: 2+ years of Utilization Review experience, denials and appeals experience, and knowledge of evidence-based guidlines (MCG and ... activities. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Screens denials for possible reconsideration, peer to peer, or formal appeal.… more
- Beth Israel Lahey Health (Burlington, MA)
- …coding of CPT/HCPCS/ICD-9/ICD-10 codes. 6. Identifies, reviews, and interprets third party denials 7. Initiates corrected claims and appeals according to payer ... Billing Office. 16. Assists the supervisor with the resolution of claims issues, denials , appeals and credits. 17. Works with the cash team to resolve unapplied… more
- Houston Methodist (Houston, TX)
- …coding 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 and monitoring the coding-specific clinical charges and denial… more
- TEKsystems (Addison, TX)
- …to strengthen appeal arguments. Additional Skills & Qualifications: - Proven experience as an Appeals and or denials Specialist or in a similar role within a ... processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials , appeals , and arbitration processes, including knowledge of… more
- WellSpan Health (York, PA)
- …Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care facilities. + ... Committee. + Works closely with Medical Director to identify trends in payor denials and appeals . + Serves as point of contact for System acute care utilization… more
- University of Utah (Salt Lake City, UT)
- …+ Demonstrated knowledge of revenue cycle. + Working knowledge of insurance denials , appeals and expected reimbursement rates. + Experience presenting findings ... PRN39530B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt **Patient… more
- R1 RCM (Salt Lake City, UT)
- …, you will help our hospital clients by serving as an expert on appeals and denials management where claims were denied by either governmental contractors ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...**Here's what you will experience working as a Clinical Appeals Nurse:** + Conduct a detailed review of patient… more
- Beth Israel Lahey Health (Burlington, MA)
- …lives.** Identifies, reviews, and interprets third party payments, adjustments and denials . Initiates corrected claims, appeals and analyzes unresolved third ... Assists the Billing Supervisor with the resolution of complex claims issues, denials , appeals and credits. 17.Works with cash team to resolve unapplied cash. 18.… more
- Beth Israel Lahey Health (Charlestown, MA)
- …of America) Identifies, reviews, and interprets third party payments, adjustments and denials . Initiates corrected claims, appeals and analyzes unresolved third ... Assists the Billing Supervisor with the resolution of complex claims issues, denials , appeals and credits. 17) Works with cash team to resolve unapplied cash.… more
- Stanford Health Care (Palo Alto, CA)
- …criteria and guidelines to optimize patient outcomes and manage healthcare costs. 4. Denials and Appeals Management: Address and manage denials by ... Working in collaboration with Physician Advisors, Financial Services, Compliance, Denials Management, Patient Access, Clinical Documentation Integrity, Billing, and… more
- UNC Health Care (Chapel Hill, NC)
- …to coder questions and provide training and education. This position processes and appeals insurance coding denials . This position analyzes coded records for ... surgery, and ancillary cases). 3. Faxes, tracks, and monitors coding denials and appeals on both inpatient and outpatient cases. Reviews coding insurance … more
- The 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
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... ensure compliance with Signature Healthcare Hospital standards, prompt notification of denials , questionable cases and cases referred for outside review. Monitors… more
- WMCHealth (Valhalla, NY)
- …expedited appeals . + Participate in peer-to-peer review with payors and/or complete appeals as required to overturn denials . + Provides assistance to initial ... to discuss cases and problems. + Participates in daily review of aggregate denials / appeals with the Medical Director, peer, or the Clinical Review Supervisor. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. ... denied claims for complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims to ensure successful… more
- Beth Israel Lahey Health (Danvers, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. ... denied claims for complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims to ensure successful… more
- BrightSpring Health Services (Louisville, KY)
- …requirements + Extensive experience in working with Payer requirements, ADR requests, Denials , Appeals , RAC/ZPIC responses + Ability to prioritize tasks and ... to ensure timely processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all payor types striving to… more
- University of Virginia (Charlottesville, VA)
- …assigned AR responsibility. + Performs inpatient/outpatient follow up and working insurance denials , appeals claims as defined by payer and departmental rules. ... the knowledge of medical billing and coding guidelines to resolve insurance denials and guarantor/patient inquiries. The representative must be able to respond… more
- University Medicine (Providence, RI)
- …of insurance guidelines + Problem-solving skills to research and resolve discrepancies, denials , appeals , collections. + Customer service skills for interacting ... all claims prior to submission. + Timely follow up on insurance claim denials , exceptions or exclusions. + Utilize monthly aging accounts receivable reports to… more