- HCA Healthcare (Nashville, TN)
- **Description** **Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient ... for benefits may vary by location._ We are seeking a(an) Coding Operations Education and Appeals Consultant for our team to ensure that we continue… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …Administration or related field preferred, but will consider collective experience, training and education . . 5 years as an Appeals Specialist or equivalent ... appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal… more
- UNC Health Care (Chapel Hill, NC)
- …questions and provide training and education . This position processes and appeals insurance coding denials. This position analyzes coded records for ... and send for rebilling if required. 5. Generate coding appeals for insurance denials with sound... guidelines and conventions. 12. Participates in and provides education sessions as needed on specific coding … more
- Houston Methodist (Houston, TX)
- … Charges & Denials Specialist is responsible for coordinating and monitoring the coding -specific clinical charges and denial management and appeals process in a ... coding staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in… more
- R1 RCM (Salt Lake City, UT)
- …Official Guidelines for Coding and Reporting. Every day you will work on the OBP Coding Operations Team. To thrive in this role, the Coding Associate II ... LCD's/NCD's for medical necessity + Communicating with other departments to recommend coding guidance for charge corrections, appeals processes, and patient… more
- Tidelands Health (FL)
- …coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations. + Work with HIM operations as needed to ... acute care hospital or physician's office or successful completion of Tidelands Health coding cross-training program ** Education ** : + High school graduate or… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- The Senior Coding Specialist is responsible for performing coding tasks required to promote efficient operation of the physician practices within Chesapeake ... when necessary to ensure patient care + Complete all assigned charge entry, coding , billing, & follow up in timely manner. + HOLD Bucket/worklist-assist & train… more
- Vanderbilt University Medical Center (Nashville, TN)
- …advance health and wellness through preeminent programs in patient care, education , and research. **Organization:** Regulatory Oversight **Job Summary:** JOB SUMMARY ... of Compliance; + Identification of best practices and control procedures over operations and/or patient care to promote regulatory compliance; + Assistance in… more
- Nuvance Health (Danbury, CT)
- …operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with local case management ... organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination Leader* will be responsible for… more
- CVS Health (Hartford, CT)
- …support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and ... United States. In this role as Medical Director MPO (Medical Policy & Operations ) you will be responsible for providing clinical expertise and business direction in… more
- Prime Healthcare (Ontario, CA)
- …members to join our corporate team! Responsibilities TheVice President of Health Plan Operations and Claims is responsible for the development and execution of Claim ... Operations strategies, end-to-end Claim process automation, optimization and management,...techniques and metrics. Someone with significantclaims experienceincluding PDR's, Disputes, Appeals and Recoveries. Sound intriguing, then you will be… more
- Houston Methodist (Houston, TX)
- …in resolution. Engages the coding follow up team for any medical necessity or coding related appeals . + Assures accounts are completed and worked at a high ... required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This… more
- UNC Health Care (Chapel Hill, NC)
- …unique communities we serve. Job Summary The Vice President for Revenue Operations - Patient Finance provides visionary leadership for UNC Health's back-end Revenue ... Cycle operations ; including both Hospital and Professional operations ....payment posting & reconciliation, cash management, technical denial prevention, appeals & resolution, and continuous optimization of revenue cycle… more
- Houston Methodist (Houston, TX)
- …appropriate billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any ... medical necessity or coding related appeals . **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Stays current on collection procedures of various payors and industry… more
- Henry Ford Health System (Detroit, MI)
- …reports of findings and meets with providers and medical office staff to provide education and training on accurate coding practices and compliance risks. + ... compliance monitoring processes, and assessing regulatory compliance of HFH operations . PRINCIPLE DUTIES AND RESPONSIBILITIES: + Conducts internal investigations,… more
- Tufts Medicine (Lowell, MA)
- …Profile** **Summary** This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this ... obtained through extensive work experience and may require vocational or technical education . Works under limited supervision for non-routine situations and may be… more
- Elevance Health (Cerritos, CA)
- …using clinical appropriateness guidelines. The **Associate Medical Director, Clinical Operations (Surgery)** is responsible for supporting the medical management ... ordering providers when consistent with applicable clinical criteria. + Provide education regarding applicable clinical criteria. + Perform first level provider … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Nurse in MA required. Bachelor's degree preferred + Experience with the Provider appeals process required; coding and claims knowledge preferred + 4+ years ... a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations, enrollment, claims processing,… more
- Mohawk Valley Health System (New Hartford, NY)
- …+ Work closely with internal teams, including Legal, Risk Management, and operations to enhance compliance efforts. + Monitor healthcare industry trends and changes ... and compile statistical analysis. + Serves as the primary RAC and appeals liaison for the hospital, including preparation of quarterly statistical summaries on… more
- State of Colorado (Lakewood, CO)
- …Director and Deputy Executive Director - Oversees strategic direction and operations for the department + Administrative Services Office - Provides division ... services (fleet, facilities, warehousing, material management and fabrication) to support the operations and programs of CDPS divisions + Human Resources Office -… more