- TEKsystems (Addison, TX)
- …to strengthen appeal arguments. Additional Skills & Qualifications: - Proven experience as an Appeals and or denials Specialist or in a similar role within a ... processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials , appeals , and arbitration processes, including knowledge of… more
- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an ... expert on clinical appeals and denials management. Every day you will support client hospitals where claims were denied or underpaid by governmental contractors,… more
- Trinity Health (Springfield, MA)
- …Shift **Description:** Requires BSN At **Mercy Medical Center** the **Utilization Review/ Appeals & Denials ** **RN** performs utilization review with payers, ... participation as well as commercial payer specific guidelines to prevent denials and revenue loss. Our professionalism, punctuality, attendance, teamwork, and… more
- Amaze Health (Denver, CO)
- …Amaze Health is a company dedicated to empowering our patients with all the tools, resources, and medical support they need to take charge of their own healthcare. We ... don't just take care of people, we partner with them. Join our innovative team as we change healthcare in America, one patient at a time. We are looking for an independent, personable, fast learner to help us provide the best possible experience for every one… more
- Houston Methodist (Houston, TX)
- …coding staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a ... At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial… more
- University of Virginia (Haymarket, VA)
- …an accurate and timely manner. + On-line data entry of certification/authorizations and denials / appeals are communicated to HSF, PFS and other Access staff and ... in a Utilization/Case Management/Pre-Arrival role where prior authorizations, prior certifications, or appeals of denials for the same were pursued. Relevant… more
- BronxCare Health System (Bronx, NY)
- Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute ... action in order to improve outcomes. - Maintains an excel log related to denials / appeals activities in order to monitor successful appeals . - Assists with… more
- R1 RCM (Salt Lake City, UT)
- …you will do initial reviews, call insurance companies to resolve authorization and claim denials , write appeals and letters to insurance companies to resolve ... analytics, AI, intelligent automation, and workflow orchestration. As our Denials and AR Senior Analyst, you will help R1...denials , and follow up on appeals to the point of exhaustion or payment. To… more
- BrightSpring Health Services (Louisville, KY)
- …for all payor types striving to minimize lost revenue. Conducts analysis on denials and appeals and identifies trends that present process improvement and ... Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN...all areas of clinical claim pre and post audit, appeals submission, and reporting to Palmetto in response to… more
- RWJBarnabas Health (Oceanport, NJ)
- …is primarily responsible to ensure the staff is properly validating clinical and technical denials to ensure appeals are accurately pursued. In this role, you ... + At least five years managed care appeal experience + Focused denials and appeals management experience + Must have excellent interpersonal, oral, and written… more
- CommonSpirit Health (Sacramento, CA)
- …denied claims to determine validity and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, ... This position will be a part of the specialized Denials Management team. This individual meets with case management...to Peer Reviews + Experience submitting written and verbal appeals + Unrestricted license in field of practice in… more
- Guidehouse (Birmingham, AL)
- …Medical Record + Making outbound calls to Insurance Companies to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting ... or equivalent. + 0-2 years medical provider experience working with UB04, appeals & denials . **What Would Be Nice to Have** **:** + Basic computer skills.… more
- RWJBarnabas Health (Oceanport, NJ)
- …Analyst, Appeals is primarily responsible for validating clinical and technical denials to ensure appeals are accurately pursued. Daily work includes ... Data Analyst, Appeals , Fulltime, Remote, NJReq #:0000176993 Category:Billing/Collections/Registration Status:Full-Time Shift:Day...ordering medical records, entering denials , and calling payers to gather account information as… more
- Nuvance Health (Danbury, CT)
- …leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with ... will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of collaboration,… more
- Stanford Health Care (Palo Alto, CA)
- …criteria and guidelines to optimize patient outcomes and manage healthcare costs. 4. Denials and Appeals Management: Address and manage denials by ... Working in collaboration with Physician Advisors, Financial Services, Compliance, Denials Management, Patient Access, Clinical Documentation Integrity, Billing, and… more
- Beth Israel Lahey Health (Danvers, MA)
- …lives.** Identifies, reviews, and interprets third party payments, adjustments and denials . Initiates corrected claims, appeals and analyzes unresolved third ... + Assists the Billing Supervisor with the resolution of complex claims issues, denials , appeals and credits. + Works with cash team to resolve unapplied cash. +… 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 ... payer work queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when necessary. + Resolves… more
- UNC Health Care (Chapel Hill, NC)
- …to coder questions and provide training and education. This position processes and appeals insurance coding denials . This position analyzes coded records for ... surgery, and ancillary cases). 3. Faxes, tracks, and monitors coding denials and appeals on both inpatient and outpatient cases. Reviews coding insurance … more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... ensure compliance with Signature Healthcare Hospital standards, prompt notification of denials , questionable cases and cases referred for outside review. Monitors… more
- UCLA Health (Los Angeles, CA)
- …tracking cases and maintaining updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution ... world-class healthcare organization by ensuring compliance in regulatory audits and appeals . Leverage your expertise to support UCLA Health's commitment to accuracy… more
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