• Sr Appeals / Denials Specialist

    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
    TEKsystems (11/21/24)
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  • Clinical Appeals & Denials Manager

    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
    R1 RCM (10/22/24)
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  • Registered Nurse RN Utilization Review…

    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
    Trinity Health (11/16/24)
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  • Patient Navigator - Denials /Medical…

    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
    Amaze Health (11/13/24)
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  • Coding Charges & Denials Specialist…

    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
    Houston Methodist (09/18/24)
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  • Exclusive Posting for Community Health Team…

    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
    University of Virginia (11/16/24)
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  • Appeals Manager, Department of Utilization…

    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
    BronxCare Health System (09/18/24)
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  • Denials & AR Senior Analyst

    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
    R1 RCM (11/22/24)
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  • Director of Clinical Denials Management…

    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
    BrightSpring Health Services (11/22/24)
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  • Supervisor, Appeals , Remote

    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
    RWJBarnabas Health (11/20/24)
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  • Physician Advisor Denials Management

    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
    CommonSpirit Health (09/20/24)
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  • Central Denials Account Representative…

    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
    Guidehouse (11/02/24)
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  • Data Analyst, Appeals , Fulltime, Remote

    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
    RWJBarnabas Health (11/19/24)
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  • AVP Care Coordination

    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
    Nuvance Health (10/26/24)
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  • Utilization Mgmt ED RN - Case Management…

    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
    Stanford Health Care (09/21/24)
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  • Denial Specialist - Hybrid

    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
    Beth Israel Lahey Health (11/10/24)
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  • Revenue Cycle Specialist - Plastics (Medical…

    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
    Houston Methodist (09/21/24)
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  • Medical Coder Auditor-HIM Coding & CDI Quality

    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
    UNC Health Care (09/04/24)
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  • Director Case Management

    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
    Brockton Hospital (09/14/24)
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  • Audit and Appeals Specialist

    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
    UCLA Health (11/06/24)
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