- Aveanna Healthcare (Naples, FL)
- …minimal supervision or instruction. Documents effectively resulting in no technical or clinical denials subsequent to review of documentation by payers Maintain ... (OT) to join our team! You will utilize your clinical expertise to assess, teach, and deliver therapy interventions...members and family. Serve as a resource consultant for clinical staff. Supervises other personnel (OTA, HHA) as applicable.… 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...including but not limited to: DRG downgrade, DRG Validation, Clinical Validation, diagnosis codes not supported, and/or general coding… more
- Northwell Health (Melville, NY)
- …utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness ... Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect… 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...appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… 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...appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- Houston Methodist (Sugar Land, TX)
- …DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information ... opportunities to both operational and clinical stakeholders. The Senior Denials Management Specialist position collaborates with physicians, case managers,… more
- HCA Healthcare (Ocala, FL)
- …opportunity. We want your knowledge and expertise! **Job Summary and Qualifications** The Clinical Denials Coding Review Specialist is responsible for ... **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want...as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. This job… 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
- Saratoga Hospital (Saratoga Springs, NY)
- HIS Denials Specialist (Inpatient) Location: Saratoga Hospital, 211 Church Street, Saratoga Springs, NY 12866 Employment Type: Full Time Shift/Schedule: 8a-4p ... About the Role We're looking for a dedicated HIS Denials Specialist to join our team and...This position provides a vital link between inpatient coding, clinical documentation improvement, Patient Access (PA) and Patient Financial… 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 ... to reimbursement, denials , status, etc. 6. Evaluates clinical denials for validity and probability to...win rates. 12. Assists in documentation review in the clinical documentation specialist role when needed. Working… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This ... HMS, Hyland, BARRT) to ensure all follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals, or routes cases for … more
- Community Health Systems (Franklin, TN)
- … Documentation Improvement Professional required or + CCDS - Certified Clinical Documentation Specialist required Equal Employment Opportunity This organization ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA)… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... with the System Business Office related to appeals, denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and incoming fax… more
- Texas Health Resources (Arlington, TX)
- …with a top-notch health care company? We're looking for a qualified_ Coder II ( Denials ) _like you to join our Texas Health family._ Position Highlights + Work ... Certified Professional Coder Upon Hire REQUIRED or CCS-P - Certified Coding Specialist - Physician-based Upon Hire REQUIRED and Other Specialty certification such as… more
- Rochester Regional Health (Rochester, NY)
- …resolve the issues resulting in denial/underpayment and to formally appeal. The specialist will conduct comprehensive reviews of clinical documentation to ... SUMMARY The C & D specialist is responsible for reviewing accounts which have...claims processing and accounts receivable collections. The Medical collection specialist must have the Ability to learn and understand… more
- BJC HealthCare (St. Louis, MO)
- …for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion...government and commercial plans. This individual will be handling clinical denials and sending them to a… more
- Covenant Health Inc. (Knoxville, TN)
- …the CDI certification with a CCS certification. Apply/Share Job Title CDI SPECIALIST CLINICAL ID 4425376 Facility Covenant Health Corporate Department Name ... Overview Clinical Documentation Integrity Specialist , Clinical...Monitors activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported.… more
- University of Southern California (Arcadia, CA)
- …Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay ... recommendations on query structure, process, and workflow. Responds to coding denials with clinical justifications and coding conventions. Maintain… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
