• Director -Utilization and Denials

    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
    WellSpan Health (10/08/24)
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  • Medical Appeals Coding Specialist SR

    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
    University of Utah (10/09/24)
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  • Sr. Director Clinical Revenue…

    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
    HonorHealth (09/28/24)
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  • Corporate Director of Clinical

    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
    Prime Healthcare (08/29/24)
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  • Director Case Management

    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
    Brockton Hospital (09/14/24)
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  • Executive Medical Director Revenue Cycle

    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
    AdventHealth (11/04/24)
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  • Market Director Utilization Management

    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
    Catholic Health Initiatives (09/19/24)
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  • Physician Advisor Clin Res Mgm / Clinical

    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
    Hartford HealthCare (10/22/24)
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  • Associate Director - Field Reimbursement…

    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
    Bayer (11/04/24)
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  • Executive Director - Social Services - MSH…

    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
    Mount Sinai Health System (09/23/24)
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  • Psychiatrist Senior Medical Director

    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
    UPMC (09/25/24)
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  • Specialist-Quality Assurance Denial Escalation

    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
    Baptist Memorial (10/16/24)
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  • Denial Operations Coordinator

    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
    Nuvance Health (10/30/24)
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  • Physician Advisor

    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
    WMCHealth (10/08/24)
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  • Chief Medical Officer

    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
    HCA Healthcare (10/26/24)
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  • Billing Specialist, Sr

    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
    University of Utah (09/05/24)
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  • Manager, Utilization Management RN *FT/Days

    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
    Providence (11/04/24)
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  • Case Manager I -Transition Planning -Sharp…

    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
    Sharp HealthCare (10/04/24)
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  • Manager, Revenue Cycle - Revenue Integrity

    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
    Houston Methodist (10/02/24)
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  • Claims Coding Specialist

    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
    Whitney Young Health Center (08/10/24)
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