- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... or other absences. Provide daily administrative assistance to Denial Prevention leadership and clinical reviewers. Manage incoming...Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and… more
- Hartford HealthCare (Farmington, CT)
- …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... related to denial turnaround times, appeal success rates, and denial reduction targets. * Denials Prevention * . Analyze denial patterns to identify root causes… more
- UNC Health Care (Kinston, NC)
- …Reviews all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and ... for issues related to reimbursement, denials , status, etc. 6. Evaluates clinical denials for validity and probability to overturn, proactively gathers… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial ... and communicating trends and root cause to support future prevention with internal customers and stakeholders as well as...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… more
- CommonSpirit Health (Englewood, CO)
- …and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, crafting compelling appeal ... discuss the needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely… more
- Hartford HealthCare (Farmington, CT)
- …of medical records, coding and clinical documentation to validate or appeal payer denials . . Prepare, document and submit appeals for DRG denials , ... turnaround times, appeal success rates, and denial reduction targets. ** Denials Prevention ** . Analyze denial patterns to...Serve as the primary contact with payers on DRG-related denials . Effectively communicate the clinical and coding… 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 ... third party payer work queues for complex payers and resolve accounts. + Manages denials and appeals efforts. Creates and submits appeals when necessary.… more
- Nuvance Health (Danbury, CT)
- …admission criteria for all levels of care) * Understanding of approaches to denials management * Familiarity with clinical documentation requirements * Working ... expertise related to appropriate utilization/level of care (LOC) and appropriate clinical documentation. Provides oversight for other Physician Advisors for both the… more
- HCA Healthcare (Austin, TX)
- …medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge ... managers and hospital staff in the reduction of payer denials and in the denial and appeals ...for evidence-based clinical practice, patient safety, and clinical loss prevention to facility leadership and… more
- Houston Methodist (Houston, TX)
- …model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention . A champion of a progressive care management model, ... position promotes innovative strategies while fostering interprofessional collaboration across clinical and administrative domains. This position leads enterprise-wide initiatives… more
- Huron Consulting Group (Chicago, IL)
- …met. + Performance Tracking and Improvement: Provides analysis and reports of utilization, denials , and appeals KPIs, trends, patterns, and impacts to resources. ... Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new… more