- St. Luke's Health System (Twin Falls, ID)
- …a great place to work. **What You Can Expect:** Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- Healthfirst (NY)
- …OR Dental Hygienist Preferred Qualifications: + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, ... and Responsibilities: + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- Healthfirst (NY)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently: + ... Work within a framework that measures productivity and quality for each Specialist against expectations + Additional duties as assigned **Minimum Qualifications** +… more
- UCLA Health (Los Angeles, CA)
- …commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory audits related ... updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each case's resolution process + Develop internal… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy… more
- Elevance Health (Plano, TX)
- …our specialty pharmacies, our infusion centers, and the home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - ... sites used for collaboration, community, and connection. The **Referral Specialist II** is responsible for providing support to a... II** is responsible for providing support to a clinical team in order to facilitate the administrative components… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- University of Michigan (Ann Arbor, MI)
- Revenue Cycle Coding Supervisor - Appeals & Denials Apply Now **Job Summary** The Denial Coding Supervisor provides subject matter expertise in physician medical ... activities. This position oversees the Physician Billing (PB) Denial Coders and Appeals and Denial Coordinators, ensuring the accuracy and efficiency of denial… more
- Genesis Healthcare (Seven Fields, PA)
- …with our Clinicians in Action professional development program. Responsibilities The Denials and Appeals Specialist is responsible for the follow up of denied ... Part-Time team members. + **Support for New Grads & Clinical Fellows:** Our Powerback Clinical Mentorship Program...response from the payer and takes appropriate action, including appeals , based on the type of denial. Documents all… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4770759) Apply Board Certified Behavior Analyst (BCBA), ( Clinical Behavioral Specialist II) - Grand Junction… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
- Billings Clinic (Billings, MT)
- …Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN Clinical Coding Specialist FINANCE (Billings ... weeks (Exempt) Starting Wage DOE: $32.06 - $40.07 The Clinical Coding Specialist RN will play a...skills to medical record, and extract supportive documentation for appeals . Report any issues to the department managers and… more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist (Critical Care) performs other related duties as ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Rush University Medical Center (Chicago, IL)
- …by the Care Management Department and Rush University Medical Center. 9. Coordinates clinical appeals process and participates in in compliance investigations as ... on the circumstances of each case. **Summary:** This position reviews initial clinical facility and physician denials, documents appeals for clinical… more
- Insight Global (Skokie, IL)
- Job Description Insight Global is looking for a clinical denials specialist to join the team at one of your healthcare clients in Chicago. As a Clinical ... perspective. This person will be responsible for preparing appeals and communication with the clinical team members. With a strong focus on maximizing patient… more
- Catholic Health Services (Farmingdale, NY)
- …are taken. Collaborate with internal teams to gather necessary medical documentation and clinical data to support the appeals process. Develop and maintain a ... Overview The Quality Assurance Regulatory Specialist plays a pivotal role in overseeing the... plays a pivotal role in overseeing the regulatory appeals process and the release of information, ensuring compliance… more
- Houston Methodist (Houston, TX)
- …Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial management and appeals process in a ... collaborative environment with revenue cycle management and clinical partners at various Houston Methodist facilities. This position will be responsible for working… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more