- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree 2 years of experience - hospital billing, processing claim edits, denials , appeals and managing accounts receivable. Experience with Epic Resolute ... Hospital Billing or similar hospital billing systems. In lieu of Bachelor's: 5 years of experience in a lead/supervisory role OR 7+ years of progressive experience in revenue cycle accounts receivable for a large hospital or health system PREFERRED… more
- US Physical Therapy (Uniondale, NY)
- …Manage commercial insurance claims from submission through payment + Follow up on denials , rejections, and appeals to ensure reimbursement + Communicate with ... insurance carriers and patients to resolve issues + Track A/R reports and maintain accurate patient account records + Collaborate with team members to improve billing and collection processes **Qualifications** + 2+ years of experience in medical… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate documentation and detailed recordkeeping of notifications to members… more
- Sun Pharmaceuticals, Inc (Washington, DC)
- …expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals , exceptions, denials , coding and payer payment guidelines, ... payer policies, sites of care, understanding of coding guidelines (CPT/J-Code/ICD-10), statutory or commercial pricing structures or mandates, and quality programs related to value based care and clinical care pathways. Responsibilities include: + Incorporate… more
- Stony Brook University (East Setauket, NY)
- …business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue ... limited to:** + Prepare and submit hospital claims. Review denials . Investigate coding issue. Audits. + Follow-up on rejected...denied claims, improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection… more
- CommonSpirit Health (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- WMCHealth (Valhalla, NY)
- Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: ... Details: Job Summary: Decrease the monies lost to insurance companies due to denials . Generate appropriate appeals , both retrospective and concurrent, based on… more
- Community Health Systems (Franklin, TN)
- …in Artiva, HMS, Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to ... for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal departments, and… more
- Rush University Medical Center (Chicago, IL)
- …vary depending on the circumstances of each case. **Summary:** The system manager of denials prevention and appeals , working in a remote environment will lead ... **Responsibilities:** 1. Oversee the Middle Revenue Cycle Audit and denials team members and appeals process, ensuring...Cycle Audit and denials team members and appeals process, ensuring timely and accurate submission of … more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... and intensity of services provided. + Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not… more
- Nuvance Health (Danbury, CT)
- …Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and incoming fax queue. 10. Reviews ... Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders in ensuring… 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, while ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the... and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- Hartford HealthCare (Farmington, CT)
- …review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... multiple denials , prioritize tasks, and ensure timely submission of appeals . . Experience with electronic health record (EHR) systems, coding software, and… more
- McLaren Health Care (Mount Pleasant, MI)
- …responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… 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
- 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 ... and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop coder education… more
- BronxCare Health System (Bronx, NY)
- …for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely ... tracking and trending of all denials and appeals , prepare weekly status reports, attend necessary meetings to assist the department attain its objective of… more
- Omaha Children's Hospital (Omaha, NE)
- …management for insurance and government collections to include claims, A/R follow-up, denials and appeals . This includes supervising, monitoring, and analyzing ... **Schedule: FT, Days, denials exp required (flexible hours)** At Children's Nebraska, our mission is to improve the life of every child through exceptional care,… more
- Molina Healthcare (San Antonio, TX)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or... appeals and denials . * Customer service experience. * Strong organizational and… more
- Mount Sinai Health System (New York, NY)
- …terms. + Ensure timely and appropriate communication with payers for authorization, denials , and appeals . + Collaborate with physicians and clinical teams ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals … more
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