- 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
- Beth Israel Lahey Health (Charlestown, MA)
- …important role in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will ... to gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in...to Revenue Cycle Leadership. . Perform process review of denials by hospital departments, and provide clinical … 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
- 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
- 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
- CVS Health (Columbus, OH)
- …concurrent and prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director will perform appeals in their "base ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...lead daily rounds. **Required Qualifications:** Minimum 3-5 years of clinical practice experience. Two (2) + years of experience… more
- Community Health Systems (Sarasota, FL)
- …to six years related experience. Previous healthcare financial services experience or appeals / denials experience + Education: Nursing Degree ( Associate or ... manage caseload without jeopardizing timely filing 5. Demonstrates excellent technical and clinical skills by drafting credible, defensible appeals 6. Conducts… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN… more
- Robert Half Finance & Accounting (Irving, TX)
- …responsible for Cash Flow. The position is responsible for ensuring claims, denials , and appeals are efficiently processed, and resolving billing-related issues. ... Description The Revenue Cycle Director is responsible for overseeing revenue cycle management...revenue trends; and is responsible for coding education to clinical and coding/billing staff. In addition, this position will… more
- Community Health Systems (Franklin, TN)
- …and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities, and readmission reduction initiatives. The ... hospital stays with portals, faxes and phone calls. The Utilization Review Clinical Specialist will monitor adherence to the hospital's utilization review plan 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
- AdventHealth (Altamonte Springs, FL)
- …including LOS, cost per case, avoidable days, resource utilization, readmission rates, concurrent denials , and appeals . . Uses data to drive decisions and ... delay and other data for specific performance and/or outcome indicators as determined by Director of Care Management. . Documents key clinical path variances and… 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
- 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
- AdventHealth (Daytona Beach, FL)
- …of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine legitimacy of hospital admission, ... UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations. The UM… more
- HCA Healthcare (Rochester, NH)
- …a collaborative atmosphere and a patient focused environment. Assists in the investigation of clinical and personnel issues as director by the Director of ... required clinical /legal referral documentation from referral source and makes clinical determination in conjunction with Program Director , as needed.… more
- HCA Healthcare (Cypress, TX)
- …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
- Guthrie (Sayre, PA)
- …Insurance Billing Specialists I and related support staff. Works closely with Director , Manager, Supervisor and Application Analyst on day to day priorities and ... necessary action to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing procedures to identify potential… more