- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager ** , you will serve ... clinical denial management. **Here's what you will experience working as a Clinical Appeals & Denials Manager :** + Serve as a leader and mentor to Clinical… more
- Hartford HealthCare (Farmington, CT)
- …for the development and implementation of an effective HIM Coding denials program consistent with regulatory and healthcare revenue cycle industry standards. ... collecting data to monitor progress. *_Position Responsibilities:_* *Key Areas of Responsibility* * Denials Resolution* . Manages the HIM Coding Denial work queue and… more
- R1 RCM (Boise, ID)
- …accounts. Responsibilities include calling insurance companies to resolve authorization and claim denials , writing appeals and letters to insurance companies to ... resolve denials , and following up on appeals to the point of exhaustion or payment. Essential...worklist. Obtain prior approval from a Lead, Supervisor, or Manager for all modifications to a UB-04; including, but… more
- Guidehouse (Birmingham, AL)
- …to resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/ Manager as needed with various projects. + Escalate ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...+ 0-2 years medical provider experience working with UB04, appeals & denials . **What Would Be Nice… 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
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: The… more
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… 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 ... Supervisor. + Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… 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
- Priority Health Care (Marrero, LA)
- …AR work lists provided by the manager in a timely manner. + Write appeals using established guidelines to resolve claim denials with a goal of one contact ... also involves ensuring timely response from third-party payors, processing payor denials , documentation requests, and appeals , and monitoring day-to-day… more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… 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
- 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
- Highmark Health (Pittsburgh, PA)
- …benefits for members, improving payment integrity, and optimizing the experience of denials , appeals , and grievances. The ideal candidate outlines the strategic ... **.** This includes a strong grasp of claims intake, adjudication, payment, appeals , denials , and grievances along with familiarity with various claim… more
- Surgery Care Affiliates (Boise, ID)
- …Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures. + Works all ... denials and corrected claims collaborating with the biller and/or Business Office Manager , insurance payers and/or patients on past due accounts. + Follow center… 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
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …Office is opened daily and comments are entered in the system for authorization, denials and EOB's timely, scanned in DoclLnk and filed in monthly Business Office ... folder. + Discuss denials with UR staff and update Denial Tracker accordingly....prepare patient or insurance refund. + Request charts, prepare appeals and charts for mailing, documenting Denial Tracker in… 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
- Stanford Health Care (Palo Alto, CA)
- …cash posting of all hospital charges from all payors. The Senior Manager assists the Director in establishing the organizational priorities and operational ... performance of the Hospital Revenue Cycle. The PFS Senior Manager acts as a liaison between PFS operations and...insurance claim editing and billing, insurance follow-up, denial and appeals + Serve as a contact/resource to other departments… 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