- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who...UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of… more
- University of Southern California (Alhambra, CA)
- …for coding-related denials , triage denied claims to distinguish coding-related denials versus clinical -related denials , evaluating claims deemed ... & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related… 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 ... Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE… more
- BronxCare Health System (Bronx, NY)
- …best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials ... and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible...to assist the department attain its objective of managing denials and appeals . Responsibilities -Types, utilizing a… 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
- Penn Medicine (East Petersburg, PA)
- …Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn ... each day. Are you living your life's work? Job: Denials Management Specialist Hours: Day shift hours, start time...the resolution of the denied claim. + Performs all appeals and denial recovery procedures needed to appropriately and… more
- Guthrie (Sayre, PA)
- …and root causes; develop strategies to reduce preventable denials + Ensure appeals are written and submitted timely, with clinical accuracy and regulatory ... Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management...responsible for the oversight and management of all payer denials , appeals , and audit processes within the… more
- Garnet Health (Middletown, NY)
- …is responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate ... The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials … more
- NTT America, Inc. (Plano, TX)
- … to join our team. NTT DATA is seeking to hire a **Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end delivery… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...limited to the following: accounts receivable days, cash collections, denials , avoidable write-offs, staff productivity and work quality and… more
- HCA Healthcare (Nashville, TN)
- …and expertise! **Job Summary** We are seeking a diligent and experienced Senior Manager , Clinical Review, Quality Control to ensure the quality and accuracy ... compliance team, and enhancing the overall quality of our clinical processes. The Senior Manager will analyze...intervention from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of… 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
- University of Southern California (Arcadia, CA)
- …recommendations on query structure, process, and workflow. Responds to coding denials with clinical justifications and coding conventions. Maintain ... for both formal and informal education for physicians, nursing, and other clinical staff. + Meets established productivity targets for record review and appropriate… more
- Community Health Systems (Franklin, TN)
- …management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… 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); Bachelor's Degree in Nursing;… 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 ... **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered… more
- Highmark Health (Pittsburgh, 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
- Fallon Health (Worcester, MA)
- …regarding the grievance/appeal. + Acts as the initial investigator for provider appeals related to filing limit, claim denials , claim payment, retrospective ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
- Crouse Hospital (Syracuse, NY)
- …Care Managers in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to ... and outreach programs. Crouse's Care Coordination team is hiring a Care Coordination Manager who is responsible for providing day to day management of the RN… more
- Virginia Mason Franciscan Health (Burien, WA)
- …care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical documentation integrity, and identification of trends in the over ... for the cost of care. 3. The Physician Advisor will conduct clinical reviews on cases referred by case/utilization management and/or other healthcare professionals… more
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