- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as ... types striving to minimize lost revenue. Conducts analysis on denials and appeals and identifies trends that...position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address… 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
- Mount Sinai Health System (New York, NY)
- …Shares denial data with physicians and collaborates on strategies to reduce denials . Works collaboratively with the Medical Centers Appeals Management Program. ... **Job Description** The Director of Case Management is responsible for the...engage internal and external stakeholders in the improvement of clinical case management, outcomes management processes and throughput. **Qualifications**… more
- Bayer (Houston, TX)
- …and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals , and denials ; + Covermymeds - portal access experience a plus; ... **Associate Director - Field Reimbursement - Oncology - South...Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals . Develop collaborative working partnerships with HCPs and Office… more
- Bayer (Denver, CO)
- …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 - Denver/Utah** **Associate Director -… more
- Bayer (Los Angeles, CA)
- …and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals , and denials ; + Covermymeds - portal access experience a plus; ... minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - Southern California** **Associate Director… more
- Bayer (WI)
- …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 Great North** **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
- 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
- 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
- HCA Healthcare (Sarasota, FL)
- …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
- Sharp HealthCare (San Diego, CA)
- …or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/UM of any quality issues.Attends hospitalists rounds, as required, to ... discuss high risk patients requiring case management follow up.Attends clinical in-services or required operational/ clinical training sessions. + Act as a… 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 ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… more
- Ellis Medicine (Schenectady, NY)
- …MIDAS per policy. + Prints/copies the chart to fax or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data ... information per policy. + Assists Utilization Management with initial clinical review requests as needed. + Notifies Case Manager...entry of insurance authorizations and denials . + Denial Management Activities + Assists Denial Management… more
- Houston Methodist (Houston, 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …provider + Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician ... your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service requests made by BCBSMA members and providers. The Physician Reviewer… more