- 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)
- …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
- 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
- Community Health Systems (Franklin, TN)
- **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely ... HMS, Hyland, BARRT) to ensure all follow-up dates are current. + Analyzes denials to determine appropriate actions, completes appeals , or routes cases for… more
- Nuvance Health (Danbury, CT)
- …*Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for...appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work queue and… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information...contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of… more
- University of Southern California (Alhambra, CA)
- …federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with… more
- Fairview Health Services (St. Paul, MN)
- **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the ... pertaining to billing, coding, and documentation. The Inpatient Coding Denials Specialist will also handle audit-related and...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… more
- Addiction Recovery Care (Lexington, KY)
- …and stewardship are key elements of everything we do! We are hiring a Denials Resolution Specialist to our growing team! Under direct supervision the ... Denials Resolution Specialist is responsible for resolving...defined communication and escalation channels. + Carry out insurance appeals + Resolves work assigned according to the prescribed… more
- BJC HealthCare (St. Louis, MO)
- …Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level ... About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion .... Collaborates to develop best practices procedures to prevent denials . + Effectively communicates with the Clinical Appeals… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Medical Billing & Denials Specialist Department: Patient Financial ServicesLocation: Massena HospitalHours Per Week: 40Schedule: Monday - Friday ... 8AM-4PM SUMMARY: A Medical Billing and Denials Specialist is responsible for managing the...fee schedules, DRGs, and reimbursement procedures. + Claims and Appeals Processing: Submits and follows up on insurance claims;… 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
- Penn Medicine (East Petersburg, PA)
- …shape our future each day. Are you living your life's work? Job: Denials Management Specialist Hours: Day shift hours, start time between 07:00am-9:00am ... are met in an appropriate manner. Responsibilities: + Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve… more
- Robert Half Office Team (Carmel, IN)
- Description Our team is seeking a detail-oriented Medical Denials Specialist to join a fast-paced healthcare environment and ensure accurate, timely resolution ... communicate with payers to facilitate claim resolution. + Prepare and submit appeals and supporting documentation as needed. + Collaborate with billing staff,… more
- HCA Healthcare (Brentwood, TN)
- …purpose and integrity. We care like family! Jump-start your career as an Appeals Specialist today with Parallon. **Benefits** Parallon offers a total rewards ... vary by location._** Come join our team as an Appeals Specialist . We care for our community!...for reconsideration. + Identify contract protection to leveraged overturn denials . + Argue appeals that prevent claim… more
- UNC Health Care (Kinston, NC)
- …all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and second levels of an ... the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation… more
- Molina Healthcare (Tampa, FL)
- …subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers,... appeals and denials . * Customer service experience. * Strong organizational and… more
- Healthfirst (FL)
- …types of claim denials , member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently:** + **Research ... within a framework that measures productivity and quality for each Specialist against expectations** + **Work independently exercising judgment starting the case… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals ,...regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending.… more
- TEKsystems (Addison, TX)
- …terminology,medical biller,anesthesia Additional Skills & Qualifications - Proven experience as an Appeals Specialist or in a similar role within a healthcare ... processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials , appeals , and arbitration processes, including knowledge of… more
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