- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals and Denials Manager ** , you will serve as an ... **Here's what you will experience working as a Clinical Appeals and Denials Manager ** + Responsible for the oversight of department supervisor(s)… more
- Genesis Healthcare (Seven Fields, PA)
- …expertise with our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up ... Part-Time team members. + **Support for New Grads & Clinical Fellows:** Our Powerback Clinical Mentorship Program...appeal letters supporting the claim and reimbursement. Performs all appeals and denials recovery procedures needed to… more
- WMCHealth (Hawthorne, NY)
- Denials Manager Company: NorthEast Provider Solutions Inc. City/State: Hawthorne, NY Category: Professional/Non- Clinical Department: Business Office Union: ... (https://pm.healthcaresource.com/cs/wmc1/#/preApply/28373) Internal Applicant link Job Details: Job Summary: The Denials Manager 's responsibilities include identifying all … more
- Hartford HealthCare (Farmington, CT)
- …works collaboratively with appropriate teams to prevent future denial. . Coordinates clinical appeals process and participates in compliance investigations as ... as needed to determine the appropriate course of denial appeals . . Maintains accurate, clear, timely documentation related to...Works with and provides education to HHC staff on denials issues related to reimbursement, clinical criteria,… more
- Hartford HealthCare (Farmington, CT)
- …and works with others as needed to determine the appropriate course of denial appeals . * Collaborates with clinical staff and/or outside providers to obtain ... other common practices across the system. *_JOB SUMMARY_* The Denials Specialist 1 is responsible for HIM Coding denial...further information to be used in the coding and appeals process. * Creates written appeals utilizing… more
- Beth Israel Lahey Health (Charlestown, MA)
- …important role in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will ... making a difference in people's lives.** Reporting to the Manager , Patient Financial Services, the Clinical Analyst...to gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in… 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 ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...the process; assumes the responsibility for coordinating and appealing clinical denials per department policy; develops any… more
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN… more
- Priority Health Care (Marrero, LA)
- …AR work lists provided by the manager in a timely manner. + Write appeals using established guidelines to resolve claim denials with a goal of one contact ... also involves ensuring timely response from third-party payors, processing payor denials , documentation requests, and appeals , and monitoring day-to-day… more
- Community Health Systems (Franklin, TN)
- …and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities, and readmission reduction initiatives. The ... hospital stays with portals, faxes and phone calls. The Utilization Review Clinical Specialist will monitor adherence to the hospital's utilization review plan to… more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… more
- UTMB Health (Galveston, TX)
- …Operations (RCO) including team leads and specialists ( denials /follow-up). The Manager interacts with UTMB leadership, including clinical and finance. ... Manager , Hosp/Professional Ins Follow Up - Revenue Cycle...Responsible for timely and accurate account resolution, including payer appeals for all denials and underpayments. +… more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… more
- Sharp HealthCare (San Diego, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN)… more
- Sharp HealthCare (La Mesa, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... 1 **Shift Start Time** **Shift End Time** Master's Degree; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's Degree in Nursing;… more
- HCA Healthcare (Rochester, NH)
- …colleagues invested over 156,000 hours volunteering in our communities. As a RN Manager Behavioral Health with Frisbie Memorial Hospital you can be a part of ... need to succeed in our organization. We are looking for an enthusiastic RN Manager Behavioral Health to help us reach our goals. Unlock your potential! **Job Summary… more
- Surgery Care Affiliates (Boise, ID)
- …Total Education, Vocational Training, and Experience: + High school graduate. Previous Clinical , Accounts Receivable, Medical Billing appeals and patient billing ... Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures. + Works all … more
- Highmark Health (Wexford, PA)
- …all regulatory and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit ... lieu of a degree + 3 years in a clinical nursing role + Current State of PA RN...**Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case… more
- Houston Methodist (Katy, TX)
- …but not limited to: insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. The ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...with external partners. + Analyzes operations to avoid unnecessary denials and write-offs (financial), decrease agings and identify problematic… more
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