- Oracle (Salem, OR)
- …this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing the ... clinical and reimbursement tasks such as charting, documentation, and coding by applying power of generative AI. Our diverse...Claim Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA).… more
- Cognizant (St. Paul, MN)
- Provider Appeals & Grievances Specialist (remote) This is a remote position open to any qualified applicant that lives in the United States. Summary: We are ... seeking a dedicated Provider Appeals & Grievance Specialist with1 to 2...managed care plans or directly with CMS Billing and Coding -Medical Insurance Knowledge of Member/Provider Appeals and… more
- PedIM Healthcare (Crystal River, FL)
- …Florida. We are currently seeking a detail-oriented and experienced Medical Billing Specialist to join our team. If you're passionate about healthcare finance, have ... Follow up on unpaid or denied claims and handle appeals as needed. Work with patients to address billing...is a plus. Proven experience as a Medical Billing Specialist in a healthcare setting. Strong knowledge of medical… more
- Elevance Health (Mason, OH)
- …RHIT certification as a Registered Health Information Technician, CCS as a Certified Coding Specialist , CIC as a Certified Inpatient Coder, or Certified Clinical ... DRG Coding Auditor Principal ** Virtual: _** _ ?...appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). How you will make...Documentation Specialist (CCDS). Requires minimum of 10 years experience working… more
- Globus Medical, Inc. (Collegeville, PA)
- …Position Summary : Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support to customers from the ... initial processing of received documentation through prior authorization, appeals support, detailed claims review, and hotline support. The Patient Access … more
- Robert Half (Minnetonka, MN)
- Description We are looking for a detail-oriented Denials Specialist to join our team in Minnetonka, Minnesota on a contract basis. In this role, you will be ... underlying issues and recommend corrective actions. Prepare and submit appeals with complete and accurate supporting documentation within established deadlines.… more
- CVS Health (Oklahoma City, OK)
- …is a fulltime teleworker opportunity in Oklahoma. The Senior Claim Data Specialist handles end-to-end processes associated with claim data management. This person ... Fundamental Components: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. Applies medical necessity… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …and communicate relevant information to the originating physician, facility, or specialist Apply knowledge of product lines and regulatory requirements in processing ... by phone or online before processing authorizations Assist with complaints and appeals related to eligibility and claims, documenting information accurately in the… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and ... MS-DRG for the purposes of appealing proposed MS-DRG and coding changes by insurance providers or their auditors. Assures...provide feedback, including identification of trends, to the Network Coding and CDMP Managers for education of the medical… more
- Oracle (Little Rock, AR)
- …this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing the ... clinical and reimbursement tasks such as charting, documentation, and coding by applying power of generative AI. Our diverse...Claim Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA).… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including… more
- McLaren Health Care (Mount Pleasant, MI)
- …ACDIS memberships + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Community Health Systems (Franklin, TN)
- …and supports initiatives that improve denial prevention and recovery processes. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, ... **Job Summary** The Appeal Specialist II reviews, analyzes, and resolves insurance denials...retractions or reimbursement impacts. + Monitors payer billing and coding updates and communicates changes to SSC and ancillary… more
- Northwell Health (Melville, NY)
- …serves as a resource for the Health System. Reviews denial trends and identifies coding issues and knowledge gaps. Job Responsibility + Serves as liaison between the ... current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness… more
- Hartford HealthCare (Farmington, CT)
- …Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS),and/or Certified Clinical Documentation ... . Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory… more
- University of Southern California (Alhambra, CA)
- …1 - 2 years Lead Experience. Required Licenses/Certifications: + Req AHIMA Certified Coding Specialist (CCS) only; or AAPC Certified Inpatient Coder (CIC) only; ... coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate,...need for appeal. Performs all 1st and 2nd level coding -related denial appeals . All tasks & duties… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... to ensure compliance. + Collaborate with clinical staff and coding teams to obtain necessary documentation for appeals... coding teams to obtain necessary documentation for appeals + Track and monitor appeal status, maintaining detailed… more
- Fairview Health Services (St. Paul, MN)
- …Info Admin or Registered Health Info Tech or Certified Inpatient Coder (CIC)or Certified Coding Specialist **Preferred Qualifications** + BS/BA in HIM + 1 year ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts...medical records and coding guidelines to formulate coding arguments for appeals and/or coding… more
- HCA Healthcare (Plano, TX)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is… more
- Huron Consulting Group (Chicago, IL)
- …the expert you are now and create your future. Job Description Summary The Coding Integrity Specialist will be responsible for executing a variety of activities ... involving the coding of medical records, resolving coding related...appeals . + 2+ years of experience as a coding auditor with proven accuracy and compliance. + Required… more
