- WellSpan Health (York, PA)
- …Committee. + Works closely with Medical Director to identify trends in payor denials and appeals . + Serves as point of contact for System acute care ... Director -Utilization and Denials Management Location: WellSpan...Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care… more
- University of Utah (Salt Lake City, UT)
- …+ Demonstrated knowledge of revenue cycle. + Working knowledge of insurance denials , appeals and expected reimbursement rates. + Experience presenting findings ... PRN40045B **Job Title** Outpatient/Provider Coder Level 3 **Working Title** Medical Appeals Coding Specialist SR **Job Grade** E **FLSA Code** Nonexempt **Patient… more
- HonorHealth (Phoenix, AZ)
- …stakeholders to identify revenue leakage, monitor charge capture activities, oversee payer clinical denials and audits, ensure optimal clean claim rates, and ... clinical charge capture accountability, documentation improvement, and payer appeals . By creating collaborative, high performing work environments, optimizing… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Claims and Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals . + Integrates and coordinates services using… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills… more
- AdventHealth (Maitland, FL)
- …**The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members of the Case ... prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization, claims management,… more
- Catholic Health Initiatives (Lexington, KY)
- …standardized criteria to determine medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals ... and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development, implementation, evaluation and… more
- Hartford HealthCare (Wethersfield, CT)
- …Other additional duties as needed. *Reports To:*Associate Medical Director of Clinical Resource Management, Utilization Management and Appeals and Denials ... *Exciting Opportunity for Physician Advisor Clinical Resource Management* Every day, over 30,000 Hartford...system. * Department Description:* The Hartford Healthcare CRM, UM, Appeals and Denials team, is a robust,… more
- Bayer (Knoxville, TN)
- …and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals , and denials ; + Covermymeds - portal access experience a plus; ... diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology Tennessee Valley** **Associate Director … more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title: Executive Director - Social Services - MSH - Full Time - Day** The Executive Director of MSH Social Work provides financial, ... programs, strategies and initiatives designed to develop, enhance and support the clinical , research and educational goals for the department(s). The Executive … more
- UPMC (Moosic, PA)
- …interests, we invite you to learn more and apply today! The Senior Medical Director provides guidance for clinical operational aspects of the program, including ... have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community...Community Care was created by a leadership team whose clinical experiences as behavioral health providers compelled them to… more
- Baptist Memorial (Memphis, TN)
- …debt from potential write-offs due to lack of collections and overturns on payer denials through the appeals process. The role will collaborate with upper ... Baptist aging AR + Prepare and submit reconsiderations and appeals to timely filing denials and follow...prospective account audits as directed by revenue cycle system director . + Assess internal and external communication of changes… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: Identifies and communicates the clinical denials in a timely manner in collaborationand working closely with the physical advisors, ... Clinical Denial Specialist nurses, Case managers, Case Management Operation...a timely manner. 5. Creates a weekly assignment for director to review for appeals . 6. Communicates… more
- WMCHealth (Valhalla, NY)
- …in daily review of aggregate denials / appeals with the Medical Director , peer, or the Clinical Review Supervisor. + Provides continuous education to ... within the regulatory timeframe of the request. + Provides clinical rational for standard and expedited appeals ....and/or complete appeals as required to overturn denials . + Provides assistance to initial clinical … more
- HCA Healthcare (Salem, VA)
- …medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge ... Officer (CMO) ensures high quality, patient-centered care by leading clinical and quality initiatives that support the provision of...managers and hospital staff in the reduction of payer denials and in the denial and appeals … more
- University of Utah (Salt Lake City, UT)
- …of benefits, pre-authorizations and to resolve claim issues. 4. Coordinates and resolves denials including the appeals process. 5. Processes changes in systems ... audits and provides feedback on billing processes at the clinical level. 7. May provide training to others on...billing process. Demonstrated computer skills. Working knowledge of insurance denials and appeals . Comments Work Environment and… more
- Providence (Mission Hills, CA)
- …Region. The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and ... patient admission, transfers, and discharges in a variety of clinical settings. Accomplishes results through multiple experienced individual staff...lieu of acute care + Previous experience working with denials and appeals in/for an acute care… 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 ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… 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 ... procedures, and provides quality reviews. Reports results of key performance metrics to director on a timely basis. **FINANCE ESSENTIAL FUNCTIONS** + Assists in the… more
- Whitney Young Health Center (Watervliet, NY)
- …more complex or problem claims or insurance types as designated by the Director . Reviews payer coding policies and procedures to ensure that the department remains ... the medical coding function; reviews the work of other medical coding and clinical staff to ensure compliance with departmental policies and other applicable laws… more