- Rush University Medical Center (Chicago, IL)
- …position. Offers may vary depending on the circumstances of each case. **Summary:** The system manager of denials prevention and appeals , working in a remote ... of Epic automation and ancillary coding software solutions. The manager will exemplify the Rush mission, vision and values...**Responsibilities:** 1. Oversee the Middle Revenue Cycle Audit and denials team members and appeals process, ensuring… more
- Hartford HealthCare (Farmington, CT)
- …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… 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
- 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
- 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
- Trinity Health (Nampa, ID)
- …and the highest quality of care. We are looking to hire a ** Clinical Resource Manager ** for our Medical Center in Nampa, Idaho ... that can't be beat. **About this position:** As a Clinical Resource Manager you will provide concurrent...by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor… 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
- 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
- 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
- City and County of San Francisco (San Francisco, CA)
- …+ Coordinates, communicates and works with various hospital and clinical departments on billing-related activities, developing workflows, troubleshooting issues, and ... + Performs revenue analysis related to charge errors, claims submission volume, denials and trends based on claim type and/or payer, including unbilled inventory… 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 Clinical Utilization Review Specialist is responsible for evaluating...insurance companies to secure coverage approvals and mitigate concurrent denials by submitting reconsiderations or coordinating peer-to-peer reviews. +… 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
- 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
- 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
- MVP Health Care (Schenectady, NY)
- …Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials : Participate in the appeals process for ... improvement. To achieve this, we're looking for a **Case Manager , Medicaid Long Term Support Program** to join #TeamMVP....after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a… more
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