- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals and Denials Manager ** , you will serve as an ... denial management. **Here's what you will experience working as a Clinical Appeals & Denials Manager :** + Serve as a leader and mentor to Clinical … more
- Houston Methodist (Houston, TX)
- …Revenue Cycle experience** At Houston Methodist, the Accounts Receivable (AR) Appeals Denials Specialist position is responsible for reviewing accounts ... documents per departmental standards. Ensures the reason for denial ( clinical , administrative, or technical) is clearly stated on the...payor's medical policy or the contract. Drafts and submits appeals using a sound argument for denials … more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non- Clinical Appeals . + Assisting Supervisor/ Manager as needed with various ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...+ 0-2 years medical provider experience working with UB04, appeals & denials . **What Would Be Nice… more
- HCA Healthcare (El Paso, TX)
- …verified denials and cooperates with denials management to provide additional clinical information for appeals . + You will educate patient and family on ... Las Palmas Medical Center team is looking for a(an) Manager of Case Management RN. HCA Healthcare is an...is unavailable. + You will proactively initiate an expedited appeals process with payers and communicates with denials… more
- Houston Methodist (Houston, TX)
- …services. This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in ... Supervisor. + Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… more
- Mount Sinai Health System (New York, NY)
- …for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). Prioritizes insurance Request/ ... Manager . In relationship to UM Insurance verification; authorizations and approvals; denials and appeals , will assist in the processing of mail. Supervises… 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 ... and ancillary cases). 3. Faxes, tracks, and monitors coding denials and appeals on both inpatient and...on both inpatient and outpatient cases. Reviews coding insurance denials and refers clinical coding denials… 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
- AdventHealth (Altamonte Springs, FL)
- …experience in utilization review (minimum two years) . Previous experience with denials and appeals (minimum one year) . Experience with precepting/mentoring ... Monday-Friday **Job Location** : Remote **The role you'll contribute:** The Divisional Manager of Utilization Management (UM) is a registered nurse, who works under… more
- Prime Healthcare (Elgin, IL)
- …for UR process along with analysis, resolution, monitoring & reporting of clinical denials . Facilitate peer-to-peer communication with payers and coordinate with ... review (UR) and the denial management (DM) process. The Manager functions as an appeal/denial expert and takes an...current with emerging industry trends on utilization review and denials management in addition to maintaining and updating payor… 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
- TEKsystems (Raleigh, NC)
- …Account Manager serves as the member of the Corporate Coding Team by reviewing denials and appeals for coding related issues * Reviews daily Epic work queues ... have billing experience, knowledge of inpatient AND outpatient (DRG, denials , claims, appeals ), experience with the hospital...* 5 Years Coding - Inpatient OR 5 Years Clinical - Related Area And Diagnosis-Related Group Analysis Required… 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 ... **Shift End Time** Master's Degree; Bachelor's Degree in Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); Certified Case … more
- Billings Clinic (Billings, MT)
- …based on medical necessity and/or payer authorization discrepancies Communicates to Case Manager on current outliers, potential outliers, and denials Identifies ... and/or continued stay Proactively interacts with payers and proactively sends clinical reviews to prevent inpatient denials Proactively communicates with… 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
- UNC Health Care (Chapel Hill, NC)
- …progression + Protects hospital revenue by working with payors for insurance authorizations, denials , and appeals + 40 hrs/week with flexible schedule options ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff… 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
- Glens Falls Hospital (Glens Falls, NY)
- …services, including charge discrepancies, CCI edits, and charge review * Serve as a clinical resource for appeals and denials * Review/update of Charge ... Patient Service Staff, this role is for you! *Team Impact* As the Clinical Nurse Manager , you will provide overall clinical and operational management during… more
- Houston Methodist (Houston, TX)
- …care benefits and post-acute care needs. + Streamlines concurrent insurance denials and/or appeals process, in collaboration with management and ... documentation. Reviews for accuracy and completion. Supports clerical and clinical functions for patients, physicians and staff. Provides administrative assistance,… more