- HCA Healthcare (Brentwood, TN)
- …Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have an exciting opportunity for ... of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is valued? If you are… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Cardinal Health (Nashville, TN)
- …performance and client satisfaction. + Resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Verifies ... insurances including all Medicaid states on paper and online. + Oversees appeals and denials management to maximize revenue recovery and minimize financial leakage,… more
- CVS Health (Nashville, TN)
- …Responsibilities** - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- CVS Health (Franklin, TN)
- …and timely support. + Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Handles phone and written ... inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals . + Identifies and reports claim overpayments, underpayments, and any… more
- Centene Corporation (Nashville, TN)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point of ... contact and liaison between assigned providers and the health plan. + Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues. + Act as department subject matter expert. +… more
- Community Health Systems (Franklin, TN)
- …appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education to include ... products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop...RN, MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Coding Specialist , Centralized Coding, Intpatient Coder Full Time, 80 Hours Per Pay Period, Day Shift inpatient Covenant Health Overview: Covenant Health is ... personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. + Reviews medical… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more
- Community Health Systems (Franklin, TN)
- …and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical ... and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case management software with documentation of… more