- Dialysis Clinic, Inc. (Sacramento, CA)
- …build relationships and gain fulfillment serving individuals in our comfortable clinical setting with a lower caregiver-to-patient ratio than other providers.The AR ... Specialist will provide continual and accurate documentation regarding eligibility,...information for assigned patients by staying in contact with clinical staff and social workers, calling insurance companies and… more
- Compass Health Network (Raymore, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- Compass Health Network (Raymore, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- Compass Health Network (St. Charles, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- Compass Health Network (St. Charles, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- Compass Health Network (St. Louis, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- Compass Health Network (Arnold, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- Compass Health Network (Arnold, MO)
- …behavior to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are ... will interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion"… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for...and reviews findings with all levels of Payment Resolution Specialist for further review. Serve as a resource to… more
- Martin's Point Health Care (Portland, ME)
- …and external customers + Cross-trains to perform either Medicare or USFHP Appeals Specialist functions as needed Education/Experience: + Bachelor's Degree or ... other internal and external partners to ensure a comprehensive appeals management process. Job Description Specialist II...providers and third-party administrators + Prepares case files on clinical member and provider appeals for review… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... clinical documentation review to establish and manage clinical and prior authorization denial appeals for...and manage clinical and prior authorization denial appeals for the Carle enterprise. Represents Carle in … more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible for providing comprehensive responses in compliance with contract, regulatory and accreditation requirements ... an administrative clinical setting, including 1-2 years medicaid managed care appeals process & Health/Human Services. + The ability to effectively interact with… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- University of Utah (Salt Lake City, UT)
- …Number** PRN39530B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt ... -H), Certified Professional Coder-Payer ( CPC -P), Certified Coding Specialist ( CCS ), Certified Coding Specialist ...certification indicated by the department, AND 3 years coding, clinical , or billing experience or equivalency (one year of… more
- St. Mary's Healthcare (Amsterdam, NY)
- …based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items and to ... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The DRG Appeals Analyst - CDI Liaison is responsible for analyzing medical records, claims data, and coding on all diagnoses and procedures (both ... the listings of International Classification of Diseases, Ninth Revision; Clinical Modification (ICD-9-CM American Medical Association Current Procedural Terminology… more
- Glens Falls Hospital (Glens Falls, NY)
- …but with emphasis on Inpatient Coding. Collaborates with Professional Coders, Clinical Document Improvement Specialists, "Scrubber" Edit Specialists and Providers to ... Emergency coding *Licenses, Certifications, Registrations* * o CCS, RHIT, RHIA, Certified Coding Specialist is Required o CDIP is a plus *Salary Range* The expected… more
- BrightSpring Health Services (Louisville, KY)
- …be met. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors,...processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all… more
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