- AdventHealth (Altamonte Springs, FL)
- …All while understanding that **together** we are even better. **Shift** : Full -time; Monday-Friday **Job Location** : Remote **The role you will contribute:** This ... position is responsible for investigating and appealing post-remit denials for all Inpatient and Outpatient clinical services across the system, as well as review… more
- Rush University Medical Center (Chicago, IL)
- …of each case. **Summary:** This position reviews initial clinical facility and physician denials , documents appeals for clinical inpatient denials , conducts ... 5 years of experience in clinical setting. * Knowledge/experience in utilization management, denials or appeals management in hospital or physician denials … more
- Nuvance Health (Danbury, CT)
- …leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with ... Leader* will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of… more
- MD Anderson Cancer Center (Houston, TX)
- …to payers utilizing specified guidelines, and facilitate timely peer to peer or appeals to mitigate denials KEY FUNCTIONS Standards of Practice a₠" Utilization ... employees and the public. The primary purpose of the Utilization Review Nurse position is to: Evaluate the necessity, appropriateness, and efficient use of… more
- University of Miami (Miami, FL)
- …of Miami Health System, "UHealth", Department of Medicine has an exciting opportunity for a Full -Time Nurse Navigator 1 to work in South Florida. The Nurse ... and supports the patient throughout the care continuum. The Nurse Navigator 1 (H) serves as a liaison between...prior authorizations requested by provider/pharmacy + Notify provider of appeals / denials + Arrange appeals /peer review… more
- City and County of San Francisco (San Francisco, CA)
- …Service (https://careers.sf.gov/knowledge/role-types/) + Recruitment ID: CCT-2320-H00083 + Employment Type: Full -Time *This role is in-person at ZSFG Hospital with ... management coding staff, physicians, and financial services. Addresses payment denials , medical necessity issues, and documentation concerns. + Instructs staff… more
- Virtua Health (Mount Laurel, NJ)
- …payment of claims.Assists customers with denial related questions.Prepares and maintains appeals for denials .Position Responsibilities:* Identifies items to be ... open communication with management regarding issues including such as documentation, denials / appeals , etc. Billing* Follows up on assigned insurances on… more
- Ascension Health (Baltimore, MD)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs ... **Details** + **Department:** Utilization Management + **Schedule:** Full -time, Day shift + **Facility:** St. Agnes Hospital + **Location:** Baltimore, MD +… more
- Beth Israel Lahey Health (Plymouth, MA)
- **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of America) **FLSA Status:** Non-Exempt **When you join the growing BILH team, ... taking a job, you're making a difference in people's lives.** full time **Job Description:** Beth Israel Deaconess Hospital-Plymouth recognizes Integrity, Respect,… more
- PeaceHealth (Vancouver, WA)
- …matter content expert and change agent with in-depth knowledge of workflow related to denials and appeals management. Performs in depth reviews of clinical DRG ... PeaceHealth is seeking a RN Denial Reviewer for a Full Time, 1.00 FTE, Day position. The salary range...downgrade denials to draft appeal letters for submission to payers.… more
- Community Health Systems (Sarasota, FL)
- …years related experience; Previous healthcare financial services experience or appeals / denials experience + Education: Master's Degree + ... ( Full -Time, Remote) The Clinical Review Analyst is a professionally licensed nurse /LPN who is responsible for effectively managing the denial/appeal process via… more
- Baylor Scott & White Health (Dallas, TX)
- …Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, manage denials and appeals . Your job is to handle claim denials from all ... Hospital. + Worked on the payer (Insurance) side of appeals and denials . + Experience in Utilization...no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor… more
- RWJBarnabas Health (New Brunswick, NJ)
- …for obtaining insurance pre-certification and prior authorization for services. Submits appeals of coverage denials . Screens and assists the uninsured ... Retrieves information from patient medical record to complete requests + Submits appeals of insurance denials in collaboration with the attending physician.… more
- Virtua Health (Mount Laurel, NJ)
- …open communication with management regarding billing and coding issues including documentation, denials / appeals , etc. * Follows up on assigned insurances on a ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Sanford Health (SD)
- …Remote SD (Central Time) **Location:** Remote, SD **Address:** **Job Schedule:** Full time **Weekly Hours:** 40.00 **Salary Range:** $26.00 - $41.50 **Job ... or business processes. Responsible for reviewing medical records and preparing clinical appeals , as appropriate, on medical necessity, level of care, length of stay,… more
- UNC Health Care (Chapel Hill, NC)
- …+ Protects hospital revenue by working with payors for insurance authorizations, denials , and appeals + Delivers mandated federal notices to patients/ ... team, third party payors and resource center. Provides information regarding denials and approvals to designated entities. Assists in coordination of practice… more
- Indian Health Service (Rosebud, SD)
- …will include; 1) Prior Authorizations/Pre-Certifications; 2) Provider Enrollment; 3) Appeals ; and 4) Accounts Receivable. Responsibilities Works closely with the ... and efficient manner. Works closely with credentialing, Staff Development Specialist, and Nurse Educator to enroll nursing and providers with South Dakota Medicaid,… more
- Mindful Support Services (Seattle, WA)
- …Therapy Group is a company dedicated to empowering therapists, psychologists, and nurse practitioners to dive into private practice, without doing all the leg ... Call insurances and use payer portals to resolve insurance denials . + Focus on denials and 120+...portal navigation + Claims reprocessing requests, corrected claims, and appeals + Navigating many commercial insurances such as Blue… more
- Hackensack Meridian Health (North Bergen, NJ)
- …workflows for utilization review activities including admission reviews, admission denials , continued stay reviews, continued stay denials , termination ... information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and… more
- HCA Healthcare (Rochester, NH)
- …+ Employee Health Assistance Fund that offers free employee-only coverage to full -time and part-time colleagues based on income. Learn more about Employee Benefits ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...and hospital-negotiated contracts. Assists medical staff in responding to appeals . Provides requested information regarding patient care and services… more