- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals and Denials Manager ** , you will serve as an ... denial management. **Here's what you will experience working as a Clinical Appeals & Denials Manager :** + Serve as a leader and mentor to Clinical … more
- Dayton Children's Hospital (Dayton, OH)
- …Home - OhioDepartment:Utilization Review TeamSchedule:Full timeHours:40Job Details:Reporting to the Manager of Utilization Management and in partnership with the ... and Resource Management; supports the development and implementation of a comprehensive denials management program. This role functions as a hospital liaison with… more
- Hartford HealthCare (Farmington, CT)
- …works collaboratively with appropriate teams to prevent future denial. . Coordinates clinical appeals process and participates in compliance investigations as ... as needed to determine the appropriate course of denial appeals . . Maintains accurate, clear, timely documentation related to...Works with and provides education to HHC staff on denials issues related to reimbursement, clinical criteria,… more
- Guidehouse (Birmingham, AL)
- …Companies to resolve claim denials and account balances. + Performing Non- Clinical Appeals . + Assisting Supervisor/ Manager as needed with various ... expert can effectively resolve the matter. + Communicate to Supervisor/ Manager areas of concern or areas of improvement. +...+ 0-2 years medical provider experience working with UB04, appeals & denials . **What Would Be Nice… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...the process; assumes the responsibility for coordinating and appealing clinical denials per department policy; develops any… more
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… more
- Houston Methodist (Houston, TX)
- …services. This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in ... Supervisor. + Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further...queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits… more
- UNC Health Care (Chapel Hill, NC)
- …to coder questions and provide training and education. This position processes and appeals insurance coding denials . This position analyzes coded records for ... and ancillary cases). 3. Faxes, tracks, and monitors coding denials and appeals on both inpatient and...on both inpatient and outpatient cases. Reviews coding insurance denials and refers clinical coding denials… more
- Priority Health Care (Marrero, LA)
- …AR work lists provided by the manager in a timely manner. + Write appeals using established guidelines to resolve claim denials with a goal of one contact ... also involves ensuring timely response from third-party payors, processing payor denials , documentation requests, and appeals , and monitoring day-to-day… more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… 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 ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); Certified Case Manager… more
- Surgery Care Affiliates (Boise, ID)
- …Total Education, Vocational Training, and Experience: + High school graduate. Previous Clinical , Accounts Receivable, Medical Billing appeals and patient billing ... Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures. + Works all … 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 ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...with external partners. + Analyzes operations to avoid unnecessary denials and write-offs (financial), decrease agings and identify problematic… more
- Tufts Medicine (Lowell, MA)
- …all escalated accounts to ensure timely resolution; submits corrected claims and appeals on administrative denials as required. 7. Responsible for correspondence ... or a role that focuses on support of daily business activities (eg, technical, clinical , non- clinical ) operating in a "hands on" environment. The majority of… more
- University of Michigan (Ann Arbor, MI)
- …with providers + Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials ; input into appeals ; share findings with providers + Review all ... RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job...areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates… more
- Cleveland Clinic (Vero Beach, FL)
- …clinical information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser ... Under the general supervision of the UM Team Manager , this individual performs UM activities which includes...information to payers, UM data collection and reporting, concurrent denials appeals process, clinical team… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …n this role, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. ... scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our...only accessible for MSK employees. Job Description RN Case Manager , Inpatient | New York, NY Exciting Opportunity at… more
- Crouse Hospital (Syracuse, NY)
- …and implements strategies for compliance. The Manager works closely with the UM and Appeals and Denials staff as both areas work in tandem to facilitate the ... utilization of resources, balanced with the patient's right to self-determination. The Manager of Case Management is responsible for providing day to day management… more
- Mount Sinai Health System (New York, NY)
- …entry of office, inpatient, and/or outpatient charges. Runs and works missing charges, edits, denials list and processes appeals . Posts denials on a timely ... claims and collection. Maintains open dialogue with the Department Administrator or Manager on billing activity and current concerns. *This role entails face-to-face… more
- Sharp HealthCare (San Diego, CA)
- …care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual ... departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.Keeps SRS… more