- Guidehouse (Birmingham, AL)
- …to resolve claim denials and account balances. + Performing Non-Clinical Appeals + Assisting Supervisor/ Manager as needed with various projects. + Escalate ... Required** **:** None **What You Will Do** **:** The Central Denials Account Representative conducts thorough account reviews to determine the appropriate… more
- St. Luke's University Health Network (Allentown, PA)
- …clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network. Utilizes ... coding errors and MUE frequency for clean claim submission + Resolve coding denials through claim correction or appeal. Claim corrections will be made after review… more
- Genesis Healthcare (Philadelphia, PA)
- …that clearly argue for payment of the services provided. Specific reasons for denials are to be addressed directly with justification for the services to be ... should be paid.Identifies and reports trends in charts that are resulting in denials .Identifies regulatory changes or trends in appeal decisions that may be in… more
- Catholic Health Services (Melville, NY)
- …liaison between patient account services, physicians. Develop/validate daily work lists for Appeals Manager . Assist with all insurance and regulatory audits and ... Catholic Health was named Long Island's Top Workplace! Job Details The Appeals and Authorization Representative will perform activities to help facilitate appeals… more
- The Mount Sinai Health System (New York, NY)
- …for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). Prioritizes insurance Request/ ... designation of alternative level of care with the UM Manager and/or Program Manager and Physician. Notifies...In relationship to UM Insurance verification; authorizations and approvals; denials and appeals , will assist in the… 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 ... and ancillary cases). 3. Faxes, tracks, and monitors coding denials and appeals on both inpatient and...software (eg Optum, Epic, PWC SMART, MS Office, Audit Manager etc.) to compile and validate medical information. **Other… more
- HCA Healthcare (El Paso, TX)
- …necessary funding is unavailable. + You will proactively initiate an expedited appeals process with payers and communicates with denials management regarding ... Las Palmas Medical Center team is looking for a(an) Manager of Case Management RN. HCA Healthcare is an...denials management to provide additional clinical information for appeals . + You will educate patient and family on… more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… more
- Arnot Health (Elmira, NY)
- …Arnot Health departments and third party payers to discourage preventable denials DUTIES AND RESPONSIBILITIES: 1. Retrospectively determines medical necessity and ... admission and stay in accordance with InterQual Criteria to assist with appeal of denials 2. Maintains a working knowledge of the requirements of 3rd party payers 3.… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. ... complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims...practice and user trends and makes recommendations to the Manager of Revenue System Operations and partners with the… more
- Beth Israel Lahey Health (Danvers, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. ... complex specialties. This role identifies and works to resolve denials to uncover root cause and accurately appeal claims...practice and user trends and makes recommendations to the Manager of Revenue System Operations and partners with the… more
- Johns Hopkins University (Middle River, MD)
- …and insurance) as needed. + Resolves claim edits + Drafts and resolves non-standard appeals . + Researches medical policies to resolve denials based on medical ... coding. + Demonstrated experience resolving third-party payor insurance processing issues, including appeals and denials . + Ability to perform on-line research… more
- Huron Consulting Group (Chicago, IL)
- …the utilization management system. + Generate and analyze reports on utilization trends, denials , and appeals to identify areas for improvement. + Ensure ... management processes and patient care outcomes. + Lead UM Denials Team Meetings to address denial management strategies. +...for Healthcare IQ and MCG Tools and oversee UM Denials Database Management for accurate documentation + Engage in… more
- UNC Health Care (Goldsboro, NC)
- …legal, and compliance guidelines Processes all assigned government and nongovernment accounts and denials for complex financial appeals , with a goal of bringing ... with regulatory, legal, and compliance guidelines. Follows rules for overturning appeals and rejections for these accounts. Completes additional research and… more
- Sharp HealthCare (La Mesa, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) - Commission for Case Manager ...organization goals including reductions in length of stay, decreasing denials , improvement of care transitions, and reduction in avoidable… more
- Sharp HealthCare (San Diego, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); Certified Case Manager… more
- Houston Methodist (Katy, TX)
- …but not limited to: insurance billing, collections, patient account resolution, appeals / denials , customer service, cash applications, revenue integrity, etc. The ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...with external partners. + Analyzes operations to avoid unnecessary denials and write-offs (financial), decrease agings and identify problematic… more
- Billings Clinic (Billings, MT)
- …based on medical necessity and/or payer authorization discrepancies Communicates to Case Manager on current outliers, potential outliers, and denials Identifies ... resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates resolve payer issues. Ensures/Maintains effective communication… more
- University of Michigan (Ann Arbor, MI)
- … will oversee the OP/Pro Medical Coder Compliance Specialists (MCCS), The PB Denials Team, and the Appeals and Denial Coordinators. These professionals support ... REVENUE CYCLE CODING MANAGER - CODING QUALITY/EDUCATION Apply Now **Job Summary**...RESPONSIBILITY** The Outpatient Facility/Professional (OP/Pro) Coding Quality and Education Manager is responsible for accurate, and timely diagnosis and… more
- University of Michigan (Ann Arbor, MI)
- …and coordinate all activities related to the response to external audit activities, appeals , and denials . Work with stakeholders to create proactive systems that ... will reduce the risk of future denials . Oversee the operational functions that require a comprehensive...are performed independently but in consultation with the Senior Manager . **What You'll Do** **LEADERSHIP** Provide leadership for the… more