- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Community Health Systems (Franklin, TN)
- …follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for clinical appeals as needed. + ... **Job Summary** The Denials & Appeals Coordinator is responsible...fast-paced environment. **Licenses and Certifications** + Certified Revenue Cycle Specialist (CRCS) - AAHAM preferred Equal Employment Opportunity This… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld… more
- Houston Methodist (Sugar Land, TX)
- …and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical...cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or… more
- BJC HealthCare (St. Louis, MO)
- …Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist...prevent denials . + Effectively communicates with the Clinical Appeals team and works with contracted… more
- University of Southern California (Alhambra, CA)
- …federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all ... denials , triage denied claims to distinguish coding-related denials versus clinical -related denials , evaluating...will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... needed for workflow or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and… more
- TEKsystems (San Bernardino, CA)
- Clinical Appeals Nurse - Revenue Cycle...role, you will play a critical part in managing clinical denials related to medical necessity, level ... Management We are looking for a Clinical Appeals Nurse to join our Revenue Cycle Management team. In this… more
- McLaren Health Care (Mount Pleasant, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... education sessions to maintain competency and knowledge of regulations in denials , utilization management, care management, clinical documentation, and… more
- Penn Medicine (East Petersburg, PA)
- …shape our future each day. Are you living your life's work? Job: Denials Management Specialist Hours: Day shift hours, start time between 07:00am-9:00am ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- UNC Health Care (Kinston, NC)
- …Reviews all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and ... for issues related to reimbursement, denials , status, etc. 6. Evaluates clinical denials for validity and probability to overturn, proactively gathers… 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
- TEKsystems (San Bernardino, CA)
- …documentation to support appeals , and following up on submitted appeals . The Clinical Appeals Specialist will work closely with a team of Licensed ... Description We are seeking a dedicated Clinical Appeals Nurse to join our...team. The ideal candidate will be responsible for managing clinical denials related to medical necessity, level… more
- Healthfirst (FL)
- …and resolution of non- clinical cases, such as: certain types of claim denials , member complaints, and member and provider appeals . The end-to-end process ... within a framework that measures productivity and quality for each Specialist against expectations** + **Work independently exercising judgment starting the case… more
- Community Health Systems (Franklin, TN)
- …the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education ... quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop… more
- University of Michigan (Ann Arbor, MI)
- …Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals Specialist has a strong knowledge of medical appeal and audit ... They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain… more
- Ochsner Health (New Orleans, LA)
- …Come make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim ... denials and underpayments to ensure accurate reimbursement. This role...The position requires strong analytical skills and collaboration with clinical and revenue cycle teams to optimize financial outcomes.… more
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